{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:50:35Z","timestamp":1781571035367,"version":"3.54.5"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","award":["HD21410, HD27869, HD27915, HD27917, HD34116, HD342"],"award-info":[{"award-number":["HD21410, HD27869, HD27915, HD27917, HD34116, HD342"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to examine whether there are racial disparities in severe maternal morbidity (SMM) in patients with hypertensive disorders of pregnancy (HDP).<\/jats:p><jats:p>\n            Study Design\u2003Secondary analysis of an observational study of 115,502 patients who had a live birth at \u226520 weeks in 25 hospitals in the United States from 2008 to 2011. Only patients with HDP were included in this analysis. Race and ethnicity were categorized as non-Hispanic White, non-Hispanic Black (NHB), and Hispanic and were abstracted from the medical charts. Patients of other races and ethnicities were excluded. Associations were estimated between race and ethnicity, and the primary outcome of SMM, defined as any of the following, was estimated by unadjusted logistic and multivariable backward logistic regressions: blood transfusion \u22654 units, unexpected surgical procedure, need for a ventilator \u226512\u2009hours, intensive care unit (ICU) admission, or failure of \u22651 organ system. Multivariable models were run classifying HDP into three levels as follows: (1) gestational hypertension; (2) preeclampsia (mild, severe, or superimposed); and (3) eclampsia or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.<\/jats:p><jats:p>\n            Results\u2003A total of 9,612 individuals with HDP met inclusion criteria. No maternal deaths occurred in this cohort. In univariable analysis, non-Hispanic White patients were more likely to present with gestational hypertension whereas NHB and Hispanic patients were more likely to present with preeclampsia. The frequency of the primary outcome, composite SMM, was higher in NHB patients compared with that in non-Hispanic White or Hispanic patients (11.8 vs. 4.5% in non-Hispanic White and 4.8% in Hispanic, p\u2009&lt;\u20090.001). This difference was driven by a higher frequency of blood transfusions and ICU admissions among NHB individuals. Prior to adjusting the analysis for confounding factors, the odds ratio (OR) of primary composite outcomes in NHB individuals was 2.85 (95% confidence interval [CI]: 2.38, 3.42) compared with non-Hispanic White. After adjusting for sociodemographic and clinical factors, hospital site, and the severity of HDP, the OR of composite SMM did not differ between the groups (adjusted OR [aOR]\u2009=\u20091.26, 95% CI: 0.95, 1.67 for NHB, and aOR\u2009=\u20091.29, 95% CI: 0.94, 1.77 for Hispanic, compared with non-Hispanic White patients). Sensitivity analysis was done to exclude one single site that was an outliner with the highest ICU admissions and demonstrated no difference in ICU admission by maternal race and ethnicity.<\/jats:p><jats:p>\n            Conclusion\u2003NHB patients with HDP had higher rates of the composite SMM compared with non-Hispanic White patients, driven mainly by a higher frequency of blood transfusions and ICU admissions. However, once severity and other confounding factors were taken into account, the differences did not persist.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1886-5404","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T00:09:56Z","timestamp":1656461396000},"page":"453-460","source":"Crossref","is-referenced-by-count":15,"title":["The Association of Race and Ethnicity with Severe Maternal Morbidity among Individuals Diagnosed with Hypertensive Disorders of Pregnancy"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6568-0201","authenticated-orcid":false,"given":"Anna","family":"Palatnik","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"McGee","sequence":"additional","affiliation":[{"name":"George Washington University Biostatistics Center, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Bailit","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Wapner","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9455-3973","authenticated-orcid":false,"given":"Michael W.","family":"Varner","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"John M.","family":"Thorp","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve N.","family":"Caritis","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Prasad","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, The Ohio State University, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan T. N.","family":"Tita","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R.","family":"Saade","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, University of Texas Medical Branch, Galveston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dwight J.","family":"Rouse","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean C.","family":"Blackwell","sequence":"additional","affiliation":[{"name":"Division of maternal fetal medicine, Department of obstetrics and gynecology, McGovern Medical School-Children's Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,12,29]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/S0140-6736(14)60696-6","article-title":"Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"N J Kassebaum","year":"2014","journal-title":"Lancet"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2019.12.008","article-title":"Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning","volume":"222","author":"S Blackwell","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"18","key":"ref3","doi-asserted-by":"crossref","first-page":"423","DOI":"10.15585\/mmwr.mm6818e1","article-title":"Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017","volume":"68","author":"E E Petersen","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1097\/AOG.0b013e31826d60c5","article-title":"Severe maternal morbidity among delivery and postpartum hospitalizations in the United States","volume":"120","author":"W M Callaghan","year":"2012","journal-title":"Obstet Gynecol"},{"key":"ref6","volume-title":"Delivery Hospitalizations Involving Preeclampsia and Eclampsia, 2005\u20132014: Statistical Brief #222. 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