Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature

Johnson, Jeff; Louis, Judette

doi:10.1016/j.ajog.2020.07.038

Cited by 108 publications

(96 citation statements)

References 114 publications

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“…Granular clinical data were not available in our data sets. Race/ethnicity on birth certificates lacks nuance and may not reflect individuals' multidimensional racial and ethnic identity 32 . Excluded women with missing data may have been at lower risk of CSMM.…”

Section: Discussionmentioning

confidence: 99%

“…As such, our findings add to the current literature describing racial/ethnic cardiovascular health disparities and further emphasise the need for equitable postpartum care. Future work for the prevention of CSMM should address these disparities using a comprehensive research framework, including a careful examination of the role of interpersonal and structural forms of racism 32 …”

Section: Discussionmentioning

confidence: 99%

“…Future work for the prevention of CSMM should address these disparities using a comprehensive research framework, including a careful examination of the role of interpersonal and structural forms of racism. 32 Using the risk assessment tools, women may be categorised as being at lowest, low, indeterminate, high or highest risk of CSMM at delivery and postpartum CSMM. The positive predictive values of CSMM among women at highest risk remain relatively low, but only a minority of women in the delivery and postpartum models scored in the highest risk category.…”

Section: Discussionmentioning

confidence: 99%

“…Race/ethnicity on birth certificates lacks nuance and may not reflect individuals' multidimensional racial and ethnic identity. 32 Excluded women with missing data may have been at lower risk of CSMM. Finally, results may not be generalisable to other study populations.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

Malhamé

Danilack

Raker

et al. 2020

BJOG

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Objectives To develop and internally validate risk prediction models identifying women at risk for cardiovascular severe maternal morbidity (CSMM). Design A retrospective cohort study. Setting An obstetric teaching hospital between 2007 and 2017. Population A total of 89 681 delivery hospitalisations. Methods We created and evaluated two models, one predicting CSMM at delivery (delivery model) and the other predicting CSMM postpartum following discharge from delivery hospitalisation (postpartum CSMM). We assessed model discrimination and calibration and used bootstrapping for internal validation. Main outcome measures Cardiovascular severe maternal morbidity comprised the following confirmed conditions: pulmonary oedema/acute heart failure, myocardial infarction, aneurysm, cardiac arrest/ventricular fibrillation, heart failure/arrest during surgery or procedure, cerebrovascular disorders, cardiogenic shock, conversion of cardiac rhythm and difficult‐to‐control severe hypertension. Results The delivery model contained 11 variables and 3 interaction terms. The strongest predictors were gestational hypertension, chronic hypertension, multiple gestation, cardiac lesions or valvular heart disease, maternal age ≥40 years and history of poor pregnancy outcome. The postpartum model comprised eight variables. The strongest predictors were severe pre‐eclampsia, non‐Hispanic Black race/ethnicity, chronic hypertension, gestational hypertension, non‐severe pre‐eclampsia and maternal age ≥40 years at delivery. The delivery and postpartum models had an area under the receiver operating characteristic curve of 0.87 (95% CI 0.85–0.89) and 0.85 (95% CI 0.80–0.90), respectively. Both models were adequately calibrated and performed well on internal validation. Conclusions These tools may help providers to identify women at highest risk of CSMM and enable future prevention measures. Tweetable abstract Risk assessment tools for cardiovascular severe maternal morbidity were developed and internally validated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

Malhamé

Danilack

Raker

et al. 2020

BJOG

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“…Recent data from the Centers for Disease Control and Prevention 2 demonstrate that Black women are 3 to 4 times more likely to die in childbirth compared with women of other races/ethnicities, a finding that persists across socioeconomic strata and is thought to be associated with social determinants of health as well as implicit and explicit biases within the health care system, resulting in inequitable treatment. 1,3,4 Hypertension complicates 10% to 20% of pregnancies in the United States and is significantly associated with maternal morbidity and mortality in the postpartum period. 1,2,5 Black women are at increased risk of hypertensive disorders of pregnancy, and hypertension and cardiovascular diseases are more frequently associated with morbidity and mortality among Black women compared with White women.…”

Section: Introductionmentioning

confidence: 99%

Racial Differences in Postpartum Blood Pressure Trajectories Among Women After a Hypertensive Disorder of Pregnancy

et al. 2020

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Key Points Question Does postpartum blood pressure trajectory after a hypertensive disorder of pregnancy differ by race? Findings In this prospective cohort study that included 1077 women after a hypertensive disorder of pregnancy, blood pressure trajectories evaluated using mixed-effects linear regression models differed significantly by self-reported race. At the conclusion of the study, 68% of Black women and 51% of White women met the criteria for stage 1 or stage 2 hypertension. Meaning This study suggests that postpartum blood pressure trajectories indicate persistence of higher blood pressures among Black women in this cohort, which may have important implications for postpartum morbidity and mortality associated with hypertensive and cardiovascular conditions in this population.

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Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality

Force

Davidson

Barry

et al. 2021

JAMA

166

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ImportancePreeclampsia is one of the most serious health problems that affect pregnant persons. It is a multisystem inflammatory syndrome that is often progressive but has an unclear etiology. Worldwide, preeclampsia is the second most common cause of maternal morbidity and mortality. It is a complication in approximately 4% of pregnancies in the US and contributes to both maternal and infant morbidity and mortality. 1 Preeclampsia also accounts for 6% of preterm births and 19% of medically indicated preterm births in the US. 1 There are racial and ethnic disparities in the prevalence of and mortality from preeclampsia. Non-Hispanic Black women are at greater risk for developing preeclampsia than other women and experience higher rates of maternal and infant morbidity and perinatal mortality than other racial and ethnic groups. In the US, the rate of maternal death from preeclampsia is higher among non-Hispanic Black women than non-Hispanic White women. 1,2 Disparities in risk factors for preeclampsia, access to early prenatal care, and obstetric interventions may account for some of the differences in prevalence and clinical outcomes. 1 These disparities largely result from historical and current manifestations of IMPORTANCE Preeclampsia is one of the most serious health problems that affect pregnant persons. It is a complication in approximately 4% of pregnancies in the US and contributes to both maternal and infant morbidity and mortality. Preeclampsia also accounts for 6% of preterm births and 19% of medically indicated preterm births in the US. There are racial and ethnic disparities in the prevalence of and mortality from preeclampsia. Non-Hispanic Black women are at greater risk for developing preeclampsia than other women and experience higher rates of maternal and infant morbidity and perinatal mortality.OBJECTIVE To update its 2014 recommendation, the USPSTF commissioned a systematic review to evaluate the effectiveness of low-dose aspirin use to prevent preeclampsia.POPULATION Pregnant persons at high risk for preeclampsia who have no prior adverse effects with or contraindications to low-dose aspirin.EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that there is a substantial net benefit of daily low-dose aspirin use to reduce the risk for preeclampsia, preterm birth, small for gestational age/intrauterine growth restriction, and perinatal mortality in pregnant persons at high risk for preeclampsia.RECOMMENDATION The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication for preeclampsia after 12 weeks of gestation in persons who are at high risk for preeclampsia. (B recommendation)

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Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature

Cited by 108 publications

References 114 publications

Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

Racial Differences in Postpartum Blood Pressure Trajectories Among Women After a Hypertensive Disorder of Pregnancy

Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality

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