519 Racial/ethnic differences in delivery gestational age and morbidity among women with hypertensive disorders of pregnancy

Abstract

We sought to determine whether there are differences between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women in delivery gestational age and disease severity (maternal and neonatal morbidity) among women with hypertensive (HTN) disorders of pregnancy. This was a retrospective cohort of all self-identified NHB and NHW pregnant women carrying non-anomalous singleton or twin gestations at a tertiary healthcare system, 2014-2020, who were diagnosed with a HTN disorder of pregnancy (gestational HTN, preeclampsia, or eclampsia). The primary outcome was delivery <37 wks. Secondary outcomes were delivery <34 & <28 wks, maternal morbidities [HELLP syndrome, acute renal insufficiency (serum Cr ≥ 1.0), severe range intrapartum BP, severe maternal morbidity (SMM, per CDC definitions)], and composite neonatal morbidity (diagnosis of IVH, PVL, BPD, NEC, ROP, or death prior to initial hospital discharge). Data were analyzed using chi2, t-test, and logistic regression. 3,522 women met inclusion criteria; 842 (23.4%) delivered <37 wks, and 29.8% were NHB. Population characteristics are shown in Table 1. NHB women were more likely to deliver <37 (29.5% vs. 21.5%), <34 (13.7% vs. 6.3%), and <28 (2.9% vs. 1.2%) wks compared to NHW women (all p<0.001). NHB women were also more likely than NHW women to have acute renal insufficiency (4.5% vs. 1.9%), severe range systolic and diastolic intrapartum BP (Table 1), SMM (5.3% vs. 2.5%), and neonatal morbidity (4.5% vs. 1.9%), all p<0.001. HELLP syndrome did not differ by race. However, NHB women had higher rates of elevated AST and/or ALT labs, Table 1. In regression models, NHB women had higher aOR of delivery <37, <34, and <28 wks, AKI, severe range intrapartum BP, SMM; their neonates had higher aOR of neonatal morbidity, Table 2. NHB women who developed HTN disorders of pregnancy were more likely than NHW women to experience severe disease, quantified by earlier delivery gestational age, lab abnormalities, and severe range BP. This increased disease severity was associated with an increase in both maternal & neonatal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)