Racial/ethnic differences in pregnancy-related hypertensive disease in nulliparous women

Objective: Hypertension and cardiovascular disease rates vary by race/ethnicity in nonpregnant adults. We aimed to examine racial/ethnic differences in prevalence and severity of hypertensive diseases during pregnancy in nulliparous women. Design, Setting, Participants: Nulliparous women with singleton deliveries and electronic medical record data on demographics and pregnancy outcomes (n=56,617) were selected from the Consortium on Safe Labor (2002- 2008). Multivariable logistic regression was performed to calculate the adjusted odds of gestational hypertension, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, superimposed preeclampsia, and unspecified hypertension for women who were non-Hispanic Black, Hispanic, Asian/Pacific Islander, and multiracial/other race/ethnicity, compared with non-Hispanic White women. Results: Non-Hispanic Black women had higher odds of entering pregnancy with chronic hypertension (adjusted odds ratio (AOR)51.43, 95% confidence interval (CI) 1.11-1.84) and had higher odds of developing mild (AOR=1.26, 95% CI 1.10-1.45), severe (AOR=1.31, 95% CI 1.10-1.57) or superimposed preeclampsia (AOR=1.98, 95% CI 1.40-2.80) compared to non-Hispanic White women. Hispanic women and Asian/Pacific Islanders had higher odds of remaining normotensive (AOR=1.22, 95% CI 1.12-1.33 and AOR=1.55, 95% CI 1.31-1.84, respectively). Conclusions: Odds for specific gestational hypertensive diseases varied by race/ethnicity among women during their first pregnancy. Non-Hispanic Black women experienced more severe disease, while Hispanic women and Asian/Pacific Islanders had an overall decreased risk compared to non-Hispanic Whites. Patterns of racial/ethnic variation associated with hypertensive diseases during pregnancy were similar to racial/ethnic associations reported for adultonset cardiovascular disease, suggesting that there may be common pathways and shared risk factors.