Race and Medicine

Race and Medicine

Disclosures: One author reports serving on advisory boards of Amgen, Novartis International AG and The Medicines Company, and received research support from the Jerold B. Katz Academy of Translational Research. Sharma and all other authors report no relevant financial disclosures.
December 20, 2021
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Nativity-related preeclampsia disparities observed in US Black women

Disclosures: One author reports serving on advisory boards of Amgen, Novartis International AG and The Medicines Company, and received research support from the Jerold B. Katz Academy of Translational Research. Sharma and all other authors report no relevant financial disclosures.
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After adjustment for sociodemographic and CV risk factors, Black women born in the U.S. or who lived in the country for an extended period experienced higher risk for preeclampsia compared with other Black women, researchers reported.

The same was not true for Hispanic women and white women in the U.S., according to the researchers.

pregnant woman in bed
Source: Adobe Stock

According to research published in JAMA Network Open, U.S. nativity may have a role in preeclampsia risk, as U.S.-born Hispanic, Black and white women had greater prevalence of obesity, smoking during pregnancy and severe stress compared with their non-U.S.-born counterparts living in the U.S.

Garima Sharma

“Hypertensive disorders of pregnancy such as preeclampsia are among the leading causes of maternal mortality in the U.S.,” Garima Sharma, MD, assistant professor of medicine at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, and colleagues wrote. “Although these associations are well documented among non-Hispanic Black women, it is unclear whether maternal nativity and duration of U.S. residence are independently associated with preeclampsia among women of other racial and ethnic groups.”

The researchers conducted a cross-sectional analysis using the racially diverse Boston Birth Cohort to identify women with singleton deliveries at the Boston Medical Center from October 1998 to Feb. 15, 2016.

This analysis included 6,096 women (mean age, 28 years; 2,400 Hispanic; 2,699 Black; 997 white).

Compared with Hispanic and white women, Black women had the highest prevalence of chronic hypertension (Black, 7.5%; Hispanic, 2.7%; white, 2.8%), obesity (Black, 24.4%; 15.8%; white, 15.2%) and preeclampsia (Black, 11%; Hispanic, 8.8%; white, 7.1%; P for all < .001).

U.S.-born Hispanic, Black and white women had greater prevalence of obesity (P for Black and Hispanic women < .001; P for white women = .003), smoking during pregnancy (P for all < .001) and severe stress (P for all < .001) compared with their non-U.S.-born counterparts.

Nativity factors

In Black women, after adjustment for sociodemographic and CV risk factors, non-U.S. birth (adjusted OR = 0.74; 95% CI, 0.55-1) and shorter duration of U.S. residence (aOR = 0.62; 95% CI, 0.41-0.93) conferred lower odds of preeclampsia, Sharma and colleagues wrote. However, in Hispanic and white women, neither maternal nativity (aOR for Hispanic women = 1.07; 95% CI, 0.72-1.6; aOR for white women = 0.98; 95% CI, 0.49-1.96) nor duration of residence (aOR for Hispanic women with residence < 10 years = 1.04; 95% CI, 0.67-1.59; aOR for white women with residence < 10 years = 1.2; 95% CI, 0.48-3.02) were associated with likelihood of developing preeclampsia.

Disparities complicated

“The findings of our study have important implications,” the researchers wrote. “First, although nativity-related differences in the prevalence of preeclampsia among non-Hispanic white and Hispanic women may be explained by differences in sociodemographic and cardiovascular risk factors, nativity-related disparities in preeclampsia among non-Hispanic Black women are more complicated and may be partly driven by factors such as racism and its associated stress as well as the lack of social support for native-born non-Hispanic Black women. Thus, interventions focused on stress reduction and improvements in social support may positively affect pregnancy outcomes among non-Hispanic Black women.”