Disparities in maternal hypertension and pregnancy outcomes: evidence from North Carolina, 1994-2003.
OBJECTIVE
To better understand disparities in pregnancy outcomes, we analyzed data from North Carolina to determine how the pattern of maternal hypertensive disorders differs among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic women across the range of maternal ages. In addition, we explored whether rates of poor birth outcomes, including low birthweight (LBW) and preterm birth (PTB), among hypertensive women differed by race.


METHODS
We restricted our analyses to births occurring between 1994 and 2003, constructing six five-year maternal age categories: 15-19 years, 20-24 years, 25-29 years, 30-34 years, 35-39 years, and 40-44 years. We used logistic regression to determine the relative contribution of race and age to incidence of maternal hypertension. All analyses controlled for the standard covariates of maternal education, marital status, and tobacco use. To assess the impact of maternal hypertension on birth outcomes, we limited the dataset to women with any hypertensive disorder and used linear regression to determine how particular race-age combinations affected outcomes. We also used logistic regression to find out how particular race-age combinations affected the likelihood of LBW and PTB.


RESULTS
The risk of hypertension differed by race, with NHB women exhibiting the highest risk and Hispanic women the lowest risk. Further, rates of hypertension increased with age. Among hypertensive women, pregnancy outcomes differed by race and age, with NHB women having the poorest outcomes (i.e., LBW and PTB) and age exhibiting a dose-response relationship in PTB and very PTB.


CONCLUSIONS
Patterns of maternal hypertension and subsequent outcomes are important contributors to persistent disparities in pregnancy outcomes.
Miranda
Marie Lynn
ML
Nicholas School of the Environment, Duke University, Durham, NC 27708, USA. mmiranda@duke.edu
Swamy
Geeta K
GK
Edwards
Sharon
S
Maxson
Pamela
P
Gelfand
Alan
A
James
Sherman
S
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000208:ethnology*; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000208:ethnology; D007226:Infant Mortality / Q000208:ethnology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008423:Maternal Age; D009657:North Carolina / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000208:ethnology*; D011256:Pregnancy Outcome / Q000208:ethnology*; D047928:Premature Birth / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult