Maternal hypertension after a low-birth-weight delivery differs by race/ethnicity: evidence from the National Health and Nutrition Examination Survey (NHANES) 1999-2006

Jia Xu, Emma Barinas-Mitchell, Lewis H Kuller, Ada O Youk, Janet M Catov, Jia Xu, Emma Barinas-Mitchell, Lewis H Kuller, Ada O Youk, Janet M Catov

Abstract

Studies have suggested an increase in maternal morbidity and mortality due to cardiovascular diseases in women with a prior low-birth-weight (LBW, <2,500 grams) delivery. This study evaluated blood pressure and hypertension in women who reported a prior preterm or small-for-gestational-age (SGA) LBW delivery in the National Health and Nutrition Examination Survey 1999-2006 (n = 6,307). This study also aimed to explore if race/ethnicity, menopause status, and years since last pregnancy modified the above associations. A total of 3,239 white, 1,350 black, and 1,718 Hispanics were assessed. Linear regression models were used to evaluate blood pressure by birth characteristics (preterm-LBW, SGA-LBW, and birthweight ≥2,500). Logistic regression models estimated the odds ratios (OR) of hypertension among women who reported a preterm-LBW or SGA-LBW delivery compared with women who reported an infant with birthweight ≥2,500 at delivery. Overall, there was a positive association between a preterm-LBW delivery and hypertension (adjusted OR = 1.39, 95% confidence interval (CI) 1.02-1.90). Prior SGA-LBW also increased the odds of hypertension, but the estimate did not reach statistical significance (adjusted OR = 1.21, 95% CI 0.76-1.92). Race/ethnicity modified the above associations. Only black women had increased risk of hypertension following SGA-LBW delivery (adjusted OR = 2.09, 95% CI 1.12-3.90). Black women were at marginally increased risk of hypertension after delivery of a preterm-LBW (adjusted OR = 1.49, 95% CI 0.93-2.38). Whites and Hispanics had increased, but not statistically significant, risk of hypertension after a preterm-LBW (whites: adjusted OR = 1.39, 95% CI 0.92-2.10; Hispanics: adjusted OR = 1.22, 95% CI 0.62-2.38). Stratified analysis indicated that the associations were stronger among women who were premenopausal and whose last pregnancy were more recent. The current study suggests that in a representative United States population, women with a history of preterm- or SGA-LBW deliveries have increased odds of hypertension and this risk appears to be higher for black women and younger women.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participant flowchart.
Figure 1. Participant flowchart.
From the population of 21,210 female participants in the NHANES 1999–2006, women who were younger than 20-year old (n = 10,509), pregnant at the interview (n = 1,173), did not complete interview and exam (n = 662), did not report previous live birth delivery (n = 2,308), or were in other race group (n = 209) were excluded. This led to a target population of 6,349 women. Women who did not answer the pregnancy history questions were excluded from the target population (n = 42). Therefore, a total of 6,307 women were included in the analysis.
Figure 2. Prevalence of hypertension in white,…
Figure 2. Prevalence of hypertension in white, black, and Hispanic women.
Overall, black women had higher prevalence of hypertension compared to white and Hispanic women. Within each race/ethnicity group, women who had a SGA-LBW or Preterm-LBW infant had higher prevalence of HTN than the BW≥2,500 g group. It was of note that even black women with BW≥2,500 g infant delivery had higher prevalence of hypertension compared to any group of white and Hispanic women.

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