Investigating Racial/Ethnic Disparities in Hypertensive Disorders in Pregnancy in the US

PROJECT ABSTRACT Compared to their Non-Hispanic White peers, Non-Hispanic Black persons in the US are 79% more likely to suffer chronic hypertension in pregnancy, 13% more likely to suffer from a hypertensive disorder of pregnancy (HDP), and 37% more likely to experience eclampsia. They are also 94% more likely to experience severe

maternal morbidity (SMM) and 60% more likely to die from a pregnancy-related cause. Modifiable risk factors at the individual and population levels, such as socioeconomic status, structural discrimination, and access to healthcare, have been associated with higher incidence and severity of HDPs, and with the progression of

HDPs to SMM. These risk factors, which have also been independently linked to SMMs and pregnancy-related mortality in the absence of HDPs, are unequally distributed along racial/ethnic lines in the state, making the causal pathways more complex. Thus, the extent to which race/ethnicity moderates the associations between

risk factors, HDP, and SMM remains complex, making it difficult for policymakers to develop effective strategies to combat racial/ethnic disparities in HDPs in the US. Our long-term goal is to develop interventions that simultaneously reduce the overall burden of HDPs and reduce the racial/ethnic disparities in HDPs. Our

overall objective for this application is to develop and validate a Markov state-transition decision model of the natural history of HDPs in the US and use that model to evaluate the potential impact of several proposed policy solutions. Our central hypothesis is that disparities in the population distribution of modifiable risk factors

(e.g., smoking, BMI, SES, discrimination, and access to high-quality healthcare) influence the observed racial/ethnic disparities in HDP and HDP-related SMMs in the US. Therefore, a decision model that captures these differences will more reliably predict the future burden of HDPs in response to different policy

interventions. To achieve the project objectives, we will pursue these two specific aims: (1) Develop and validate a Markov state-transition model of the natural history of HDP and its impact on mothers and children; (2) Estimate the potential costs and benefits of primary prevention/treatment strategies that address racial

disparities in HDP in the United States. On completion, we expect to have developed a robust decision-support tool that incorporates multilevel risk factors to predict differences in HDP burden by race/ethnicity, and that can be used to test the potential effect of proposed interventions. These positive outcomes will enable the

development and implementation of evidence-based solutions to reduce HDP disparities in the US.