Health Disparities
Hypertensive Disorders of Pregnancy and Black–White Racial Disparities in Severe Maternal Morbidity Rashida S. Smith-Webb* Rashida S. Smith-Webb Smith-Webb Smith-Webb Smith-Webb Smith-Webb Smith-Webb University of Nebraska Medical Center
Background: Limited research has examined the contribution of hypertensive disorders of pregnancy (HDP) to racial disparities in severe maternal morbidity (SMM); however, quantifying the role of HDP more precisely could help prioritize strategies to reduce disparities in SMM. We used mediation analysis to estimate the contribution of HDP to Black–White racial disparities in SMM.
Methods: We identified Black and White birthing people aged 12–55 years with deliveries in Massachusetts from 1998 to 2021 using the Pregnancy to Early Life Longitudinal Data System (N = 1,242,574). We estimated the total absolute effect of maternal race, as a proxy for exposure to racism, on SMM using generalized linear models, and applied G-estimation of a structural nested mean model to estimate the counterfactual disparity measure for the direct effect. We then calculated the proportion of the Black–White racial disparity in SMM that could be eliminated by preventing all HDP and severe HDP, separately.
Results: Black birthing people had a higher rate of SMM than White birthing people (114.0 vs. 50.4 per 10,000 in-hospital deliveries), corresponding to an excess of 63.6 events per 10,000 in-hospital deliveries (95% confidence interval [CI]: 57.9, 69.3). Under complete prevention of all HDP, the SMM disparity was reduced to 38.4 events per 10,000 in-hospital deliveries (95% CI: 33.4, 44.8), suggesting that 39.7% of the absolute Black–White racial disparity in SMM could be eliminated. Preventing severe HDP reduced the SMM disparity to an excess of 45.8 events per 10,000 in-hospital deliveries (95% CI: 40.2, 51.5), representing elimination of 27.9% of the disparity.
Conclusion: Preventing HDP could reduce Black–White racial disparities in SMM. These findings highlight the need for further research on preventive strategies among Black birthing people, with specific attention to effective messaging and adherence to prenatal aspirin, which has been shown to reduce the incidence of preeclampsia.