Racial Disparities in Comorbidities, Complications, and Maternal and Fetal Outcomes in Women With Preeclampsia/eclampsia

Sajid Shahul, Avery Tung, Mohammed Minhaj, Junaid Nizamuddin, Julia Wenger, Eitezaz Mahmood, Ariel Mueller, Shahzad Shaefi, Barbara Scavone, Robb D Kociol, Daniel Talmor, Sarosh Rana, Sajid Shahul, Avery Tung, Mohammed Minhaj, Junaid Nizamuddin, Julia Wenger, Eitezaz Mahmood, Ariel Mueller, Shahzad Shaefi, Barbara Scavone, Robb D Kociol, Daniel Talmor, Sarosh Rana

Abstract

Objective: The mechanisms leading to worse outcomes in African-American (AA) women with preeclampsia/eclampsia remain unclear. Our objective was to identify racial differences in maternal comorbidities, peripartum characteristics, and maternal and fetal outcomes.

Methods/results: When compared to white women with preeclampsia/eclampsia, AA women had an increased unadjusted risk of inpatient maternal mortality (OR 3.70, 95% CI: 2.19-6.24). After adjustment for covariates, in-hospital mortality for AA women remained higher than that for white women (OR 2.85, 95% CI: 1.38-5.53), while the adjusted risk of death among Hispanic women did not differ from that for white women. We also found an increased risk of intrauterine fetal death (IUFD) among AA women. When compared to white women with preeclampsia, AA women had an increased unadjusted odds of IUFD (OR 2.78, 95% CI: 2.49-3.11), which remained significant after adjustment for covariates (adjusted OR 2.45, 95% CI: 2.14-2.82). In contrast, IUFD among Hispanic women did not differ from that for white women after adjusting for covariates.

Conclusions and relevance: Our data suggest that African-American women are more likely to have risk factors for preeclampsia and more likely to suffer an adverse outcome during peripartum care. Future research should examine whether controlling co-morbidities and other risk factors will help to alleviate racial disparities in outcomes in this cohort of women.

Keywords: Hypertension; epidemiology; mortality.

Conflict of interest statement

Conflict of interest disclosures:

None.

Figures

Figure 1
Figure 1
Odds ratios for severe maternal complications in African American and Hispanic women with preeclampsia. African American women were significantly more likely than white women to need mechanical ventilation, develop pulmonary edema, renal failure, ARDS, stroke, acute MI, peripartum cardiomyopathy, placental ablation, pulmonary embolism, or cardiac arrest.

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Source: PubMed

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