Racial Disparities in Cardiovascular Complications with Pregnancy-Induced Hypertension in the United States

Anum S. Minhas, S. Michelle Ogunwole, Arthur Jason Vaught, Pensee Wu, Mamas A. Mamas, Martha Gulati, Di Zhao, Allison G. Hays, Erin D. Michos

Research output: Contribution to journalArticlepeer-review


Women with pregnancy-induced hypertension, defined as gestational hypertension and preeclampsia/eclampsia, are at increased risk of long-term cardiovascular disease, but less is known about the spectrum of acute cardiovascular outcomes, especially across racial/ethnic groups. We evaluated the risk of cardiovascular events at delivery associated with gestational hypertension and preeclampsia/eclampsia, compared with no pregnancy-induced hypertension, overall and by race/ethnicity. We used the 2016 to 2018 National Inpatient Sample data. International Classification of Diseases, Tenth Revision, Clinical Modification codes identified delivery hospitalizations and clinical diagnoses. Using survey weights, cardiovascular events were examined using logistic regression by pregnancy-induced hypertension status, with subsequent stratification by race/ethnicity. Among 11 304 996 deliveries in 2016 to 2018, gestational hypertension occurred in 614 995 (5.4%) and preeclampsia in 593 516 (5.2%). Black women had higher odds for preeclampsia independent of underlying comorbidities (adjusted odds ratio, 1.45 [95% CI, 1.42-1.49]) and had the highest rates for several complications (peripartum cardiomyopathy, 506; heart failure, 660; acute renal failure, 953; and arrhythmias, 418 per 100 000 deliveries). After adjustment for socioeconomic factors and comorbidities, preeclampsia/eclampsia was associated with increased risk of cardiovascular events in women of all races/ethnicities. However, risk was highest among Asian/Pacific Islander women and lowest among Black women. In sum, while Black women were the most likely to experience preeclampsia, Asian/Pacific women were the most at risk for acute cardiovascular complications during delivery hospitalization.

Original languageEnglish (US)
Pages (from-to)480-488
Number of pages9
Issue number2
StatePublished - Aug 1 2021


  • cardiovascular disease
  • eclampsia
  • heart failure
  • hospitalization
  • maternal health

ASJC Scopus subject areas

  • Internal Medicine


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