title: Pre-eclampsia in American Indians/Alaska Natives and Whites: The Significance of Body Mass Index.
abstract: Introduction The prevalence of pre-eclampsia, a major cause of maternal morbidity, varies by race, being greater in African Americans, and lower in Asians and Hispanics than in White women. Little is known about its prevalence in American Indians/Alaska Natives (AI/ANs). We estimated pre-eclampsia risk in AI/ANs compared to Whites, with consideration of the potential effect of obesity, a major risk factor for pre-eclampsia, and a condition disproportionately affecting AI/AN women. Methods This retrospective cohort study of linked birth-hospital discharge data from Washington State (2003-2013) included all AI/AN women and a sample of White first-time mothers with singleton deliveries. Logistic regression was used to estimate odds ratio (OR) and 95 % confidence intervals (CI) for pre-eclampsia risk in AI/ANs compared to Whites, first controlling for several important risk factors, and subsequently with additional adjustment for pre-pregnancy body mass index (BMI). Results AI/ANs had an increased risk of pre-eclampsia compared to Whites after controlling for all covariates except BMI (OR 1.17, 95 % CI 1.06-1.29). After further adjustment for BMI, the racial disparity in pre-eclampsia risk was greatly attenuated (OR 1.05, 95 % CI 0.95-1.16). Discussion This population-based study suggests that any increased risk in AI/ANs relative to Whites may be at least partly due to differences in BMI.
authors.affiliation: Initiative for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA. azkapoor@uw.edu.|Department of Pediatrics, University of Washington, Seattle, WA, USA. azkapoor@uw.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Zamora-Kapoor
authors.affiliation: Initiative for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA.
authors.forename: Lonnie A
authors.initials: LA
authors.lastname: Nelson
authors.affiliation: Initiative for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA.|College of Medicine, Washington State University, Spokane, WA, USA.
authors.forename: Dedra S
authors.initials: DS
authors.lastname: Buchwald
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA.
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Walker
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Mueller
mesh_terms: D000293:Adolescent; D000328:Adult; D000072957:Alaska Natives / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology*; D011159:Population Surveillance; D011225:Pre-Eclampsia / Q000208:ethnology*; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D014861:Washington / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: American Indian/Alaska Native; Body mass index; Health disparities; Obesity; Overweight; Pre-eclampsia