Latent Class Analysis Reveals Distinct Profiles Associated with Preeclampsia in Nulliparous Pregnancies

Preeclampsia is a major cause of maternal illness and death, with poorly defined risk factors in nulliparous pregnancies. This study used latent class analysis to identify patterns of social, reproductive, health, and behavior factors associated with preeclampsia in 9809 nulliparous individuals who live in a large urban area in the Southeast US. Data were obtained from a perinatal administrative database (2011-2021). Latent indicators included maternal age, sociodemographic factors, foreign-born status, pregnancy intendedness, body mass index, mental and chronic health conditions, drug use, and sexually transmitted infections (STIs). Outcomes were gestational hypertension, preeclampsia, and superimposed preeclampsia. Associations between latent classes and outcomes were examined with structural equation modeling. Of the pregnant patients, 49.1% were < 25 years old, 37.4% were foreign-born, 62.6% were married, 54.4% were on public insurance, 55.3% had unplanned pregnancies, 11.2% had mental health conditions, 5.4% had chronic health conditions, and 8.7% reported drug use. Three latent profiles emerged: Multidomain vulnerability (28%) included those more likely to be < 25 years of age with co-occurring social disadvantage, unplanned pregnancies, STIs, and drug use; social vulnerability (32%) included predominantly foreign-born patients with social disadvantage; health-behavior vulnerability (39%) included those with planned pregnancies and social advantage, but more health and behavior indicators relative to social vulnerability. Multidomain vulnerability (OR 2.0, 95% CI 1.67-2.46) and social vulnerability (OR 2.51, 95% CI 2.09-3.01) had higher odds of preeclampsia compared to the health-behavior vulnerability profile. Our latent class analysis revealed unique clustering of social, behavior, and health risk factors associated with preeclampsia among nulliparous pregnancies.