Hypertensive Disorders of Pregnancy – The Black/White Disparity

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Project Abstract The United States (US) has one of the highest maternal mortality rates in the developed world. Hypertensive disorders of pregnancy (HDP) such as gestational hypertension, preeclampsia, and eclampsia are major contributors to maternal mortality and morbidity, complicating approximately 2% to 8% of all pregnancies. In the US, Black women have disproportionately higher rates of HDP and are almost four times more likely to die from HDP compared to White women. Urgent action is required to address this racial disparity in HDP and lower the maternal mortality rate. While traditional cardiovascular risk factors are important contributors to HDP, social determinants of health (SDOH) have been identified as a fundamental cause of disease and health disparities, acting at multiple levels of influence. Yet, few studies go beyond the individual level to examine how SDOH, particularly multi-level products of structures and systems, contribute to the substantial racial gap in HDP. To address this need, I will identify contributors to HDP disparities using the socio-ecological framework. Specifically, this proposal will determine whether neighborhood-level racial residential segregation, interpersonal-level perceived discrimination, and individual-level pre-pregnancy CVD risk factors contribute to or explain the observed Black-White disparity in HDP. This multi-level research model considers the complex interplay between individual, community, and societal factors providing a comprehensive approach to understanding the etiology of HDP disparities. To do this work, I will leverage data from the Coronary Artery Risk Development in Young Adults study, a prospective cohort study of 5,114 Black and White adults (nBlackWomen=1480; nWhiteWomen =1307), age 18-30 in 1985 and followed for over 30 years. In aim 1 (neighborhood), I will determine whether racial residential segregation is associated with incident HDP among Black parous women. In aim 2 (interpersonal), I will determine whether perceived racial discrimination in the medical care setting is associated with incident HDP and whether it contributes to the Black-White disparity in HDP. In aim 3 (individual), I will determine whether pre-pregnancy CVD risk factors (defined by the American Heart Association’s Life’s Essential 8) are associated with incident HDP and whether these factors contribute to the Black-White disparity in HDP. These aims are embedded within a training plan designed to build my competence in epidemiology and health disparities research while facilitating my success as a physician-scientist specializing in women’s health. Identifying reasons for the disparities in HDP is fundamental to develop targeted and effective interventions to close the racial gap and improve maternal care in the US. This proposal will therefore address a critical and emergent public health priority to reduce maternal mortality, particularly among Black women.