Abstract 14740: Racial Disparities in Adverse Pregnancy Outcomes and Cardiovascular Health After Delivery: A Mediation Analysis in Numom2b-hhs

Abstract

Introduction: Racial disparities in risk of adverse pregnancy outcomes (APOs) and cardiovascular health (CVH) after delivery are well-established. Therefore, we sought to quantify the extent to which APOs explained racial differences in CVH. Methods: We included non-Hispanic (NH) Black and NH White individuals from the prospective, longitudinal nuMoM2b-HHS cohort. Race and ethnicity, which represent social constructs, were self-reported. APOs (hypertensive disorders of pregnancy [HDP], small for gestational age [SGA], preterm birth [PTB], and gestational diabetes mellitus [GDM]) were centrally adjudicated via medical records. The primary outcome was CVH score based on 4 metrics: body mass index, blood pressure, cholesterol, and glucose assessed at follow-up. Using a life-course approach, APOs were considered on the pathway between racial identity and CVH. Mean difference in CVH score was estimated via targeted maximum likelihood estimation (TMLE). Sensitivity analyses included alternative causal inference methods. All models were adjusted for age, study site, insurance, and fetal sex. Results: Among 2,987 birthing individuals, NH Black individuals were significantly more likely than NH White individuals to experience HDP, SGA, and PTB, and had lower (worse) CVH scores at follow-up (mean difference 0.52 [0.38-0.66]). Counterfactual disparity measures were estimated, which represent the adjusted racial difference in CVH score that would remain if no one experienced a particular APO ( Table ). Approximately 2% of the racial difference in CVH scores was due to racial differences in APOs when estimating with TMLE. Similar estimates were observed with other methods. Conclusions: A small proportion of the racial disparity in CVH years after delivery was mediated via APOs. Mitigating racial inequities in CVH will require interventions upstream of the first pregnancy (before an APO occurs) in addition to downstream risk factor control.