Preeclampsia outcomes at delivery and race

Abstract

Objective: The objective of this study was to assess how race is associated with adverse maternal outcomes in the setting of preeclampsia.Study design: This retrospective cohort study utilized the National (Nationwide) Inpatient Sample (NIS) from the Agency for Health care Research and Quality for the years 2012-2014. Women aged 15-54 with a diagnosis of preeclampsia were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. The overall risk for severe morbidity based on Centers for Disease Control and Prevention criteria was analyzed along with the risk for specific outcomes such as stroke, acute heart failure or pulmonary edema, eclampsia, and acute renal failure. The risk for severe morbidity was stratified by comorbid risk and compared by race. Log-linear regression models were created to assess risk for severe morbidity with risk ratios and associated 95% confidence intervals as measures of effect.Results: A total of 101,741 women with preeclampsia from 2012 to 2014 were included in this analysis. The risk for severe morbidity was significantly higher among non-Hispanic black women (9.8%) than non-Hispanic white, Hispanic, and all other women, respectively (6.1, 7.7, and 7.5%, respectively, p < .01). For non-Hispanic black compared to non-Hispanic white, Hispanic, and all other women, risk was higher for stroke (17.1 versus 6.5, 12.7, and 9.3 per 10,000 deliveries, respectively, p < .01) and pulmonary edema or heart failure (56.2 versus 32.7, 30.2, and 38.4 per 10,000 deliveries, respectively, p < .01). Non-Hispanic black women were also more likely than non-Hispanic white women to experience renal failure (136.4 versus 60.4 per 10,000 deliveries, p < .01). Adjusting for comorbidity, black women remained at higher risk for severe morbidity (p < .01). The risk for death was higher for black compared to non-black women (121.8 per 100,000 deliveries, 95% CI 69.7-212.9 versus 24.1 per 100,000 deliveries, 95% CI 14.6-39.8, respectively, p < .01)Conclusion: Black women were at higher risk for severe morbidity and mortality associated with preeclampsia.

Keywords: Maternal risk; preeclampsia; racial disparities.

Conflict of interest statement

Financial Disclosure

Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. The other authors did not report any potential conflicts of interest. Each author has indicated that he or she has met the journal’s requirements for authorship.

Figures

Figure 1.

Figures 1A and 1B demonstrate risk for severe morbidity with and without transfusion by race based on CDC criteria for delivery hospitalizations complicated by preeclampsia in the Nationwide Inpatient Sample from 2012 to 2014. Black women were significantly more likely than white women to experience severe morbidity with and without transfusion (p

Figure 2.

Figures 2A, 2B, 2C, and 2D demonstrate risk for stroke, acute heart failure or pulmonary edema, renal failure, and eclampsia respectively based on CDC criteria for delivery hospitalizations complicated by preeclampsia in the Nationwide Inpatient Sample from 2012 to 2014. Black women were significantly more likely than white women to experience each of these conditions (p

Figure 2.

Figures 2A, 2B, 2C, and 2D demonstrate risk for stroke, acute heart failure or pulmonary edema, renal failure, and eclampsia respectively based on CDC criteria for delivery hospitalizations complicated by preeclampsia in the Nationwide Inpatient Sample from 2012 to 2014. Black women were significantly more likely than white women to experience each of these conditions (p

Figure 3.

Figure 3 demonstrates risk for severe morbidity based on CDC morbidity by race by obstetric comorbidity score: 0, 1 or 2, and >2. This comorbidity score analysis excluded hypertensive diagnoses (chronic hypertension, gestational hypertension, mild, severe, and superimposed preeclampsia) and included maternal age Risk for severe morbidity was significantly higher for black compared to white women for each category (p