Disparities in Pregnancy-Related Hypertension Among Hispanic Subgroups: Alexandra M. Trevino, MD

Using data from the CDC Natality database, Alexandra M. Trevino, MD, of Northwestern Medicine, and colleagues studied trends in hypertensive disorders of pregnancy (HDP) among Hispanic birthing adults. The analysis showed HDP rates increased in all Hispanic subgroups from 2018 to 2023, as well that US-born individuals had higher rates of HDP than those born outside the US.

These findings highlight significant heterogeneity among Hispanic subgroups, and Trevino suggests this may be due to factors like acculturation and a more sedentary lifestyle among US-born individuals. The research aims to inform culturally tailored interventions and intentional risk screening early in pregnancy.

Trevino presented this research today, on day 1 of the American Society for Preventive Cardiology Congress on CVD Prevention, in the oral abstract, “Trends in New-Onset Hypertensive Disorders of Pregnancy Among US Adults by Place of Birth and Hispanic Ethnic Origin Group.”

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What prompted you to study HDP by Hispanic ethnic origin and place of birth, and how did you approach your analysis?

This study built off another study that was published in JAMA Cardiology by Shah and colleagues in 2022 that demonstrated significant heterogeneity among Hispanic birthing adults when they were deaggregated into ethnic origin groups. Our study, the aim was to evaluate the impact of nativity—those that were born in the United States vs those that were born outside of the United States—and its impact on trends in hypertensive disorders of pregnancy overall in Hispanics birthing individuals and in addition to different ethnic origin groups. We pulled data from the CDC Natality database, which is a public and de-identified database that records maternal health information for all live births in the United States, and then we used Joinpoint software to quantify these trends.

Were there any findings that stood out or patterns that surprised you?

When you aggregate Hispanic birthing adults into a single ethnic group, they will actually trend with lower rates compared to non-Hispanic White and Black birthing adults. What's interesting is, when you deaggregate the data, you see a lot of heterogeneity among the different subgroups.

What we saw is that incidents increased in all the Hispanic subgroups from 2018 to 2023, and interestingly, we noted that trends were higher and incidence was higher among US-born individuals compared to non–US-born individuals. Additionally, we saw that there was significant heterogeneity among rates between the different Hispanic subgroups that was masked when you aggregated the data into 1 singular ethnic group.

I was surprised by the results of our study, because I would have imagined that the non–US-born individuals would have had higher rates, because our immigrant communities face considerable challenges, both economically and with access to health care. However, I imagine that the results may be related to acculturation and assimilation, meaning adaptation of the American diet and a more sedentary lifestyle that we know are contributing factors to the development of HDP. I'm also imagining that there is some role in other social determinants of health that also impact the rates, but they have yet to be defined.

How can your findings help inform cardiovascular risk assessment and postpartum care for Hispanic patients?

The hope is that this research will promote culturally tailored interventions, with the goal of trying to reduce the incidence of HDP and subsequently the other chronic and long-term health effects that are associated with HDP. In order to do that, we need to have really intentional risk screening early on in pregnancy and very intentional follow-up postpartum.

What are next steps for this research?

There's still a lot of research that needs to be done to better elucidate why these barriers exist and why we have these disparities. I think it would be interesting to better understand the impact of dietary patterns, as well as physical activity, on the rates of HDP, in addition to better understanding the social determinants of health that may influence these rates, including economic stability or even just the physical environment of these individuals. Unfortunately, that information is not readily available on the CDC Natality database, but my hope is that we can get there.