Differential Risk of Hypertensive Disorders of Pregnancy among Hispanic Women

Abstract

Abstract. Preeclampsia and gestational hypertension are leading complications of pregnancy that also portend increased risk of future chronic hypertension. Although rates of chronic hypertension differ between non-Hispanic Caucasian and Hispanic women, few studies examined their relative rates of hypertensive disorders of pregnancy. The purpose of this study was to compare the risk of preeclampsia and gestational hypertension in a prospective cohort of normotensive, nulliparous Hispanic (n ϭ 863) and non-Hispanic Caucasian women (n ϭ 2,381). Compared with non-Hispanic Caucasian women, Hispanic women demonstrated a significantly decreased incidence of gestational hypertension (1.6% versus 8.5%; P Ͻ 0.01), but a similar incidence of preeclampsia (3.8% versus 3.7%; P ϭ 0.9). Adjusting for age, smoking, diabetes, BP, body mass index (BMI), and multiple gestation uncovered an increased relative risk (RR) for preeclampsia among Hispanic women (RR 1.9; 95% CI, 1.1 to 3.3; P ϭ 0.01), while their relative risk for gestational hypertension remained significantly decreased (RR 0.39; 95% CI, 0.22 to 0.72; P Ͻ 0.01). Among women who initially presented with hypertension during pregnancy, Hispanic women were over threefold (hazard ratio 3.3; 95% CI, 1.9 to 6.0; P Ͻ 0.01) more likely to develop preeclampsia than non-Hispanic Caucasian women. Besides Hispanic ethnicity, baseline BP, BMI, diabetes, and multiple gestation were independent risk factors for preeclampsia, whereas only baseline BP and BMI were associated with gestational hypertension. Socioeconomic status and access to prenatal care were not associated with either disorder. Hispanic ethnicity is independently associated with increased risk for preeclampsia and decreased risk for gestational hypertension. The initial presentation of hypertension during pregnancy in Hispanic women most likely represents early preeclampsia.The hypertensive disorders of pregnancy, preeclampsia, and gestational hypertension, which complicate 6 to 8% of pregnancies (1), are leading causes of maternal and fetal morbidity and mortality, and are associated with increased risk of future chronic hypertension (2). Although the characteristic placental pathology of preeclampsia is established during early pregnancy (3), there are no reliable tools for early clinical diagnosis and no effective therapies to prevent disease or improve maternal and fetal outcomes. Importantly, there are also no means to differentiate whether the new onset of hypertension during pregnancy represents gestational hypertension or preeclampsia in which proteinuria has yet to develop. More fundamentally, it remains unclear if preeclampsia and gestational hypertension represent ends of a single pathophysiological spectrum of pregnancy-induced hypertension or distinct disorders with unique biological pathways and differential risk factor profiles.Risk factors for preeclampsia have been studied extensively as preeclampsia is the hypertensive disorder of pregnancy most commonly associated with devastating complications. Nullip...

Effect of age, parity, and race on the incidence of pregnancy associated hypertension and eclampsia in the United States

“…The lower prevalence of hypertension in the general population in Hispanic people, despite the higher level of risk factors compared with other racial groups, has been previously noted [34]. Risk factors such as higher body mass index, older age, and glucose intolerance may increase the risk of developing hypertension in people within varied socioeconomic and racial backgrounds.…”

“…There are few studies available that have compared racial groups for the incidence of hypertensive disorders of pregnancy [33,34]. G1 Hispanic women have an increased risk of preeclampsia and a decreased risk of gestational hypertension than white women [34]. In a study of the New York State hospital discharge database, total hypertensive disorders of pregnancy were more frequent in blacks than Hispanic or white women; black and Hispanic women were at a greater risk Fig.…”

“…There are few studies available that have compared racial groups for the incidence of hypertensive disorders of pregnancy [33,34]. G1 Hispanic women have an increased risk of preeclampsia and a decreased risk of gestational hypertension than white women [34].…”

Obstetric Nephrology

“…Clearly, it is more difficult to make this last diagnosis, given the possible variability in BP and proteinuria. Similarly, it is often difficult to distinguish preeclampsia and GH in clinical practice because the onset of proteinuria need not occur simultaneously with that of hypertension (9). This has led to the mistaken notion that GH may "progress to preeclampsia" when, instead, the onset of proteinuria merely lags behind that of hypertension, in some cases by many weeks (9).…”

“…Similarly, it is often difficult to distinguish preeclampsia and GH in clinical practice because the onset of proteinuria need not occur simultaneously with that of hypertension (9). This has led to the mistaken notion that GH may "progress to preeclampsia" when, instead, the onset of proteinuria merely lags behind that of hypertension, in some cases by many weeks (9). It is likely that longitudinal studies including measures of systemic hemodynamics, angiogenic and antiangiogenic factors, proteinuria, and clinical outcomes will be required to convince many clinicians of this distinction between GH and preeclampsia.…”