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Meta-Analysis
. 2025 Feb 20;27(1):10.
doi: 10.1007/s11906-025-01327-6.

Factors associated with preeclampsia and the hypertensive disorders of pregnancy amongst Indigenous women of Canada, Australia, New Zealand, and the United States: A systematic review and meta-analysis

Jacqueline Stephens  1 , Eleonora Dal Grande  2 , Tayla Roberts  2 , Marianne Kerr  3 , Celine Northcott  2 , Tahlia Johnson  4 , Jessie Sleep  5 , Courtney Ryder  2
Affiliations
Meta-Analysis

Factors associated with preeclampsia and the hypertensive disorders of pregnancy amongst Indigenous women of Canada, Australia, New Zealand, and the United States: A systematic review and meta-analysis

Jacqueline Stephens et al. Curr Hypertens Rep. .

Abstract

Purpose of the review: Preeclampsia and the Hypertensive Disorders of Pregnancy (HDP) occur more frequently amongst Indigenous women and can have short- and long-term impacts on maternal and infant health and wellbeing. To understand factors associated with increased risk for Indigenous women a systematic review and meta-analysis was conducted. The PRISMA guidelines were adhered to, and the review protocol was registered on PROSPERO (Registration CRD42023381847). EndNote, Covidence and Excel were used to screen and extract data, with studies assessed using JBI critical appraisal tools.

Recent findings: Seven studies from Canada, Australia, and the United States (none from New Zealand) were included in this review. Meta-analysis showed women classified as overweight (OR 1.32, 95% CI: 1.09-1.60), obese (OR 1.88, 95% CI: 1.57-2.25), or having high mean BMI (MD 3.02 95% CI: 1.72-4.31), high mean systolic blood pressure (MD 15.19 95% CI: 12.83-17.541), or high mean diastolic blood pressure (MD 15.26 95% CI: 13.05-17.47), pre-pregnancy diabetes (OR 3.63, 95% CI: 1.66-17.94), or high microalbuminuria (OR 2.76, 95% CI: 1.40-5.43) were more likely to be diagnosed with preeclampsia. Smoking (OR 0.77, 95% CI: 0.58-1.03), alcohol consumption (OR 1.70, 95% CI: 0.76-3.81), and gestational diabetes (OR 1.74, 95% CI: 0.90-3.37) were not associated with preeclampsia. Understanding factors associated with increased preeclampsia/HDP risk amongst Indigenous women is important to minimising adverse perinatal events and future health complications. This review demonstrates current gaps in the evidence, specifically in relation to social, economic, and environmental factors.

Keywords: Hypertension; Indigenous; Pre-eclampsia [MESH]; Pregnancy; Pregnant women [MESH]; Risk factors [MESH].

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Conflict of interest statement

Compliance with Ethical Standards. Ethical Statement: All data are in the public domain. No ethical clearance was required. Conflict of Interest: The authors declare no competing interests. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Article identification and selection process: PRISMA Flowchart
Fig. 2
Fig. 2
Summary of the associations between preeclampsia/Hypertension Disorders in Pregnancy and various potential factors among Indigenous women. Footnote: CI: confidence interval; I2: I2; PE: Pre-eclampsia; HDP: Hypertension Disorders in Pregnancy; Overweight and Obese classifications are compared to normal weight as classified by Body Mass Index
Fig. 3
Fig. 3
Summary of pooled mean differences between preeclampsia/Hypertension Disorders in Pregnancy and various factors among Indigenous women. Footnote: CI: confidence interval; I2: I2; PE: Pre-eclampsia; HDP: Hypertension Disorders in Pregnancy; BMI: Body Mass Index; BP: Blood Pressure
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