Abstract
Objectives
To evaluate the relationship between hypertensive (HTN) disorders and severe maternal morbidity (SMM). To understand whether there is differential prevalence of HTN disorders by race and whether the relationship between HTN disorders and SMM is modified by race and ethnicity.
Methods
We performed a retrospective cohort study using patient-level rates of SMM for pregnancies at all 61 non-military hospitals in Washington State from 10/2015 to 9/2016. Data were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the association of HTN disorders and SMM (with and without transfusion) overall and by race. The population-attributable fraction of HTN disorders on SMM within each racial/ethnic group was calculated.
Results
Of 76,965 deliveries, 864 (1.1%) had any SMM diagnosis or procedure. All racial and ethnic minorities, except white and Asian, were disproportionally affected by preeclampsia with severe features (SF) and SMM. Overall, and within each racial/ethnic group, the SMM rate was higher among pregnancies with any HTN disorder compared to no HTN disorder (2.8 vs. 0.9%, OR 3.1, 95% CI 2.7–3.6). Race and ethnicity significantly modified the association. Overall and within each racial/ethnic group, there was a dose-response relationship between the type of HTN disorder and SMM, with more severe HTN disorders leading to a greater risk of SMM. The population-attributable fraction of HTN disorders on SMM was 20.6% for Black individuals versus 17.5% overall. The findings were similar when reclassifying transfusion-only SMM as no SMM.
Conclusions
In Washington, HTN disorders are associated with SMM in a dose-dependent fashion with the greatest impact among Black individuals.
Significance
Hypertensive disorders are a risk factor for SMM and hypertensive disorders and SMM occur disproportionately among marginalized populations.
AbstractSection What does this study add to what is already known?This study highlights that severe hypertensive disorders, especially preeclampsia with SF, disproportionately affect marginalized groups, and SMM appears to be disproportionately attributable to hypertensive disorders among people who identify as Black.
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All authors contributed to the manuscript’s conceptualization, writing, and editing. Dr. Albright and Dr. Pike performed the statistical analysis.
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Albright, C.M., Sienas, L., Pike, M. et al. Racial Disparity in Severe Maternal Morbidity Associated with Hypertensive Disorders in Washington State: A Retrospective Cohort Study. Matern Child Health J (2024). https://doi.org/10.1007/s10995-024-03920-8
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DOI: https://doi.org/10.1007/s10995-024-03920-8