Cardiovascular Outcomes in Black vs White Pregnant and Postpartum Women

Cardiovascular outcomes were found to be worse among Black vs White pregnant and postpartum women, even after adjusting for socioeconomic factors and medical comorbidities, according to a study published in the Journal of the American Heart Association.

Pregnant and postpartum women who were hospitalized between January 2007 and December 2017 were identified within the Nationwide Inpatient Sample. Outcomes included in-hospital mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy. Multivariate regression analysis was used to assess the independent association between race and in-hospital outcomes.

A total of 46,700,637 pregnancy-related hospitalizations were included in the analysis (46.4%, White women; 13.5%, Black women; 19.1%, Hispanic women). Black and Hispanic vs White pregnant and postpartum women were younger (39.9%, 34.8%, and 25.9%, respectively aged 18-24 years). Approximately 1 in 200 pregnancies among Hispanic and Black women were in those aged <18 years, compared with 1 in 500 pregnancies among White women.

Mortality and stroke trends were found to decline significantly among Black women, but to remain unchanged among White women. Mortality and cardiovascular morbidity incidence was greatest among Black women, followed by White and Hispanic women. Also, 62.3% of Black women were insured by Medicaid, whereas 61.9% of White women had private insurance.

Most Black women (71.2%) had below-median income, and 52.7% of White women were above the median income. Compared with White women, Black women had higher mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy, with adjusted odds ratios of 1.45, 1.23, 1.57, 1.42, and 1.71, respectively.

“Significant risk factors previously associated with poor pregnancy outcomes are trending up in Black women and significantly higher than [in] White women,” noted the study authors.

Study limitations include its retrospective and nonrandomized design, and the fact that the study data was obtained from an administrative database that relied on International Classification of Diseases, Ninth and Tenth Revisions codes and is subject to coding errors.

“Significant racial disparities exist in regard to in-hospital mortality and major cardiovascular events among pregnant and postpartum women,” the study authors concluded. “Acute myocardial infarction and pulmonary embolism rates are trending up significantly in all racial groups, particularly in Black women. Our current observations and estimates provide policy makers as well as healthcare administrators with needed evidence to allocate funds to social and medical programs that can help reduce health disparities and inequities in pregnant women.”

Reference

Gad MM, Elgendy IY, Mahmoud AN, et al. Disparities in cardiovascular disease outcomes among pregnant and post-partum women [published online December 16, 2020]. J Am Heart Assoc. doi:10.1161/JAHA.120.017832