662: Racial disparities in preeclampsia and growth restriction persist among women of high socioeconomic status (SES)

Abstract

Despite persistent racial disparities in placentally mediated adverse outcomes [gestational hypertension (GHTN ± preeclampsia (PREE), small for gestational age (SGA)] in the US among non-Hispanic (NH) black women compared to NH white women, it is controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in GHTN ± PREE and SGA persist among women of high SES. We conducted a population-based cohort study using US live birth records from the National Vital Statistics System, 2015-2017.We included singleton, non-anomalous pregnancies among women of high SES (those with ≥ 16 years of education and private insurance and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or both NH black & white races.The primary outcome was the diagnosis of GHTH ± PREE. The secondary outcome was SGA (birthweight < 10% and < 3% for fetal gender & gestational age). Data were analyzed using chi-square, t-test, and logistic regression. Of 11,376,439 singleton, non-anomalous pregnancies during the study period, 2,170,686 (19.1%) pregnancies met inclusion criteria; 92.9% were NH white, 6.7% NH black, and 0.4% both NH white & black races. Overall, 6.1% were diagnosed with GHTN ± PREE, 3.7% with SGA < 10%, and 0.7% with SGA < 3%. Baseline characteristics and outcomes are compared by race (Table 1). In unadjusted analyses, rates of GHTN ± PREE, SGA < 10%, and SGA < 3% were higher for women of NH black and both NH black & white races compared to women of NH white race alone. In regression models, NH black women and those with mixed NH black and NH white race had a higher odds of GHTN ± PREE and SGA (Figure 1). Among college-educated U.S. women with private insurance who are not receiving WIC, racial disparities in placentally mediated adverse outcomes in pregnancy persist. These findings suggest that factors other than socio-demographics are important in the underlying pathogenesis of placentally-mediated adverse pregnancy outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)