The Association of Race and Ethnicity With Adverse Outcomes in Women Treated for Mild Chronic Hypertension During Pregnancy [ID: 1381420

Abstract

INTRODUCTION: The effect of race and ethnicity on outcomes in the treatment of mild chronic hypertension (cHTN) in pregnancy is unknown. METHODS: This was a secondary analysis of a multicenter randomized trial of pregnant patients with mild cHTN comparing antihypertensive therapy to goal blood pressure less than 140/90 mm Hg (Active) versus usual care. Log-binomial regression assessed differences in outcomes between racial and ethnic groups among Active participants. Outcomes included a composite (preeclampsia with severe features, medically indicated preterm birth [PTB]<35 weeks, abruption, fetal/neonatal death), components of the composite, intensive care unit admission, HTN with end-organ dysfunction, low birth weight (LBW), PTB less than 37 weeks, neonatal intensive care unit admission, and small for gestational age (SGA). RESULTS: Baseline maternal characteristics of patients randomized to active treatment in the parent trial differed by race and ethnicity for age, married status, insurance, nulliparous, body mass index, tobacco use, aspirin, and prior preeclampsia. Models demonstrated increased risk of the primary composite (adjusted relative risk [aRR] 1.35 [1.05, 1.73]) among Black compared to White patients. Preeclampsia was not increased among Black (aRR 1.14 [0.87, 1.50]) or Hispanic patients (aRR 1.13 [0.82, 1.56]). Preterm birth was increased among Black (aRR 1.31 [1.02, 1.68]) and Hispanic patients (aRR 1.33 [1.00, 1.77]), and there was increased risk of LBW infants born to Black patients (aRR 1.54 [1.11, 2.14]), but not Hispanic (aRR 1.04 [0.69, 1.57]) compared to White. There was no difference in SGA between groups. CONCLUSION: Among women with mild cHTN treated to goal less than 140/90 mm Hg, baseline characteristics differed significantly, and Black and Hispanic women were at increased risk compared to White women for selected outcomes. Interventions to address disparities should further evaluate social determinants of health in addition to medical management.