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Epidemiology

Poster Session 3

(772) Hypertensive disorders of pregnancy and severe maternal morbidity according to race/ethnicity, California 2007-2018

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: The goal of this study was to assess the relationship between hypertensive disorders of pregnancy (HDP) and severe maternal morbidity (SMM) at delivery through 6-weeks postpartum (PP) by race/ethnicity. Racial/ethnic disparities in HDP and SMM are well known, and HDP confers increased risks of SMM and PP readmission.

Study Design: This historical cohort study contained birth and fetal death certificates linked to hospital discharge records for the delivery admission and PP readmissions up to 6 weeks after delivery, for nearly all inpatient deliveries in California from 2007-2018. PP readmissions excluded transfers from the delivery hospitalization. HDP were identified by International Classification of Diseases codes from the delivery hospitalization. SMM was defined by the Centers for Disease Control and Prevention index and analyzed as any SMM from delivery up to 6 weeks PP as well as by time of occurrence: at delivery only, PP only, or delivery and PP SMM. We calculated the frequency of SMM among people with and without HDP stratified on race/ethnicity. We performed logistic regression to assess the association of HDP and SMM by race/ethnicity and adjusted confounders.

Results: The frequency of SMM by race/ethnicity was between 1-2% of people without HDP and 4-7% of those with HDP (Table 1). SMM by each time of occurrence was highest among non-Hispanic Black people both with and without HDP. The highest odds ratio (OR) for HDP and SMM was observed among Hispanic people (OR=4.26, 95% confidence interval (4.17, 4.36), but the associations were similar and significantly elevated for all race/ethnicities (Table 1).

Conclusion: SMM at delivery or up to 6-weeks postpartum was 3 to 4 times more likely among pregnant people with HDP compared to those without HDP. The magnitude of the relationship between HDP and SMM was similar for all race/ethnicities although the absolute percentage of SMM was the highest among non-Hispanic Black people. These results confirm that HDP is a major risk factor for SMM, regardless of race/ethnicity.