Racial/ethnic differences in pregnancy-related hypertensive disease in nulliparous women.

OBJECTIVE Hypertension and cardiovascular disease rates vary by race/ethnicity in nonpregnant adults. We aimed to examine racial/ethnic differences in prevalence and severity of hypertensive diseases during pregnancy in nulliparous women. DESIGN, SETTING, PARTICIPANTS Nulliparous women with singleton deliveries and electronic medical record data on demographics and pregnancy outcomes (n = 56,617) were selected from the Consortium on Safe Labor (2002-2008). Multivariable logistic regression was performed to calculate the adjusted odds of gestational hypertension, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, superimposed preeclampsia, and unspecified hypertension for women who were non-Hispanic Black, Hispanic, Asian/Pacific Islander, and multiracial/other race/ethnicity, compared with non-Hispanic White women. RESULTS Non-Hispanic Black women had higher odds of entering pregnancy with chronic hypertension (adjusted odds ratio (AOR) = 1.43, 95% confidence interval (CI) 1.11-1.84) and had higher odds of developing mild (AOR = 1.26, 95% Cl 1.10-1.45), severe (AOR = 1.31, 95% Cl 1.10-1.57) or superimposed preeclampsia (AOR = 1.98, 95% ClI 1.40-2.80) compared to non-Hispanic White women. Hispanic women and Asian/Pacific Islanders had higher odds of remaining normotensive (AOR = 1.22, 95% CI 1.12-1.33 and AOR=1.55, 95% CI 1.31-1.84, respectively). Conclusions: Odds for specific gestational hypertensive diseases varied by race/ethnicity among women during their first pregnancy. Non-Hispanic Black women experienced more severe disease, while Hispanic women and Asian/Pacific Islanders had an overall decreased risk compared to non-Hispanic Whites. Patterns of racial/ethnic variation associated with hypertensive diseases during pregnancy were similar to racial/ethnic associations reported for adult-onset cardiovascular disease, suggesting that there may be common pathways and shared risk factors.