Hypertensive Disorders of Pregnancy – The Black/White Disparity

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 experience 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 these differences in outcomes and reduce the maternal mortality rate. While traditional cardiovascular risk factors are important contributors to HDP, social determinants of health (SDOH) are also thought to play a role by acting across multiple levels of influence, yet few studies have examined how these multi-level products of structures and systems shape risk for HDP. This proposal seeks to fill that gap by investigating contributors to HDP using the socio-ecological framework, evaluating whether neighborhood-level contexts, interpersonal experiences, and individual-level pre-pregnancy cardiovascular disease (CVD) risk factors contribute to differences in HDP. This multi-level research model considers the complex interplay between individual, neighborhood, and societal factors to provide a comprehensive approach to understanding the etiology of HDP. To conduct this work, I will use data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective cohort of 5,114 Black and White adults (nBlackWomen=1480; nWhiteWomen=1307), age 18–30 at baseline in 1985 and followed for over 30 years. The aims of this study are as follows: Aim 1 will evaluate whether built environment and area-level characteristics are associated with incident HDP among Black parous women; Aim 2 will assess whether interpersonal experiences within various settings are associated with incident HDP and whether they help explain Black-White differences in HDP; Aim 3 will investigate 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 differences in HDP outcomes. These aims are embedded within a training plan designed to build my competence in epidemiology and women’s health research while facilitating my success as a physician-scientist specializing in maternal health. Identifying the factors that drive differences in HDP is fundamental to developing targeted and effective interventions to improve maternal care in the US, and this proposal will therefore address a critical and emergent public health priority to reduce maternal mortality, particularly among Black women.