PREGNANCY DISORDERS AND MATERNAL CONSEQUENCES: Ethnic disparities in hypertensive disorders of pregnancy

Abstract

In brief: Ethnic disparities in hypertensive disorders of pregnancy (HDP) are well-described but poorly understood, with complex interplays between biological, environmental, socio-cultural and healthcare factors potentially contributing. This article provides a contemporary review of this topic and makes recommendations for research and clinical care to improve outcomes for minoritised women.

Abstract: HDP affect approximately one in ten pregnancies and are associated with increased risk of adverse maternal and perinatal outcomes. Despite advances in prevention of pre-eclampsia and improved management of blood pressure in pregnancy, stark disparities in HDP incidence and outcomes persist across maternal ethnic groups. This article provides a contemporaneous review of the epidemiology of ethnic disparities in HDP, potential contributors to ethnic disparities, and how maternal ethnicity is currently conceptualised and utilised as a risk factor in clinical practice. We present the challenges of utilising ethnicity as a risk factor and suggest actions needed to tackle ethnic disparities in pregnancy hypertension. Women of Black ethnic backgrounds consistently experience a higher risk of pre-eclampsia, HDP and associated adverse outcomes compared to women of other ethnicities across diverse healthcare settings. While traditional cardiovascular risk factors and socioeconomic status contribute to these disparities, they do not fully explain the observed differences. Understanding these disparities requires research examining complex interactions across biological, behavioural, environmental, socio-cultural, and healthcare system factors. Ensuring appropriate diversity in HDP research is crucial for equitable application of incoming genomic and personalised medicine advances. While the fundamental drivers of ethnic disparities in HDP remain to be fully understood, healthcare systems should prioritise optimising blood pressure control during pregnancy and postpartum for women from minoritised ethnic backgrounds. Ensuring minoritised women with lived experience are equal partners in designing and implementing research and initiatives to address these disparities will be critical to their success.

Keywords: ancestry; antihypertensives; ethnicity; hypertension; pre-eclampsia; pregnancy.

Figure 1

Overview of HDP, including UK NICE guideline recommendations on BP treatment initiation thresholds and BP target on treatments.

Figure 2

Scatterplot of country-level prevalence of HDP in women of reproductive age (15–49) by country-level socio-demographic index using the 2021 Global Burden of Disease Data (available: https://ghdx.healthdata.org/gbd-2021).