title: OS028. Hypertensive disease in pregnancy: An examination of ethnic differences and the Hispanic paradox.
abstract: BACKGROUND
  The "Hispanic Paradox" refers to the epidemiological finding that Hispanics in the US have better health outcomes than the average population despite what their aggregate socioeconomic determinants would predict.
  
  
  OBJECTIVE
  The aim of this study was to evaluate obstetric outcomes for a multiethnic population with hypertensive diseases.
  
  
  METHODS
  We performed a retrospective review of parturients with hypertensive disease delivering at Duke University Medical Center in 2005-2007. We analyzed maternal sociodemographic characteristics and ethnic differences in hypertensive disease types using Chi Square. We assessed the role of race and ethnicity on maternal and neonatal outcomes through a series of logistic regression analyses.
  
  
  RESULTS
  Nine thousand eight hundred and thirteen women delivered during the study period, and 9% had hypertensive diseases in pregnancy. There were significant racial and ethnic differences in presentation (Chi-square=39.11, p<.001) with gestational hypertension more common in Whites, chronic hypertension in African Americans, and mild preeclampsia in Hispanics. The overall incidence of preeclampsia was lower in Hispanics. However, severe preeclampsia rates were equal across groups. Hispanics were more likely to be uninsured, younger, enter prenatal care later, and least likely to complete high school. There was no significant difference in smoking or parity. Stratified analyses by ethnicity showed that the relationship between severe preeclampsia and comorbidities (IUGR, LBW, ICN admission) were least pronounced in Hispanics and strongest in African American women.
  
  
  CONCLUSIONS
  Despite similar rates of severe preeclampsia and adverse sociodemographic characteristics, Hispanic women with severe preeclampsia had better pregnancy outcomes than African-American or White women with the disease.
authors.affiliation: Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University School of Medicine, Durham, United States.
authors.forename: M
authors.initials: M
authors.lastname: Small
authors.affiliation: Obstetrics and Gynecology, Associates for Women's Healthcare, Louisville, United States.
authors.forename: A
authors.initials: A
authors.lastname: Carr
authors.affiliation: Epidmiology and Public Health, Yale University School of Public Health, New Haven, United States.
authors.forename: T
authors.initials: T
authors.lastname: Kershaw
authors.affiliation: Obstetrics and Gynecology, Duke University School of Medicine, Durham, United States.
authors.forename: H
authors.initials: H
authors.lastname: Brown