{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:12Z","timestamp":1787721612684,"version":"build-2784847793"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,7,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Adverse pregnancy outcomes (APOs) are associated with increased hypertension risk. Black women experience higher rates of APOs and hypertension compared with White women, but whether APOs contribute to Black\u2010White hypertension disparities remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">The nuMoM2b\u2010HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers\u2010To\u2010Be\u2013Heart Health Study) prospectively recruited nulliparous pregnant people at 8 US centers (2010\u20132013) with follow\u2010up 2 to 7\u2009years postpartum (2014\u20132017). Race, which represents a social construct, was self\u2010identified. The primary outcome was incident hypertension at follow\u2010up. APOs included hypertensive disorders of pregnancy, preterm birth, and small\u2010for\u2010gestational age birth. Potential confounders (psychological health, social factors, and health behaviors) were assessed via validated questionnaires. We used targeted maximum likelihood\u2010based estimation to estimate Black\u2010White hypertension differences that would remain if racial disparities in APOs were eliminated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 3335 participants (17% Black; 83% White; mean [SD] age, 27.6 [5.1] years), APO incidence was higher in Black versus White individuals (rate differences [RDs] per 1000 births: hypertensive disorders of pregnancy: 52.5 [95% CI, 20.0\u201385.1]; preterm birth: 45.4 [95% CI, 20.8\u201370.1]; small\u2010for\u2010gestational age: 102.4 [95% CI, 75.8\u2013129.1]). Incident hypertension at median 3\u2009years postpartum was higher in Black versus White individuals (RD, 107.1 [95% CI, 69.6\u2013144.4]). APOs mediated the racial disparity in hypertension; eliminating Black\u2010White disparities in APOs would decrease the Black\u2010White disparity in hypertension by 18.2% for hypertensive disorders of pregnancy (RD, 87.6 [95% CI, 36.1\u2013139.2]), 16.3% for preterm birth (RD, 89.6 [95% CI, 41.7\u2013137.6]), and 13.9% for small\u2010for\u2010gestational age (RD, 92.2 [95% CI, 41.6\u2013142.9]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Black\u2010White differences in hypertension were partially mediated by APOs. APOs may represent a pregnancy\u2010specific pathway contributing to racial disparities in hypertension.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.035681","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:22:12Z","timestamp":1783074132000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Racial Differences in Adverse Pregnancy Outcomes and Incident Hypertension: A Mediation Analysis"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0156-1219","authenticated-orcid":false,"given":"Lucia C.","family":"Petito","sequence":"first","affiliation":[{"name":"Northwestern University Feinberg School of Medicine","place":["Chicago"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5813-5993","authenticated-orcid":false,"given":"Xiaoning","family":"Huang","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine","place":["Chicago"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9933-5155","authenticated-orcid":false,"given":"C. Noel","family":"Bairey Merz","sequence":"additional","affiliation":[{"name":"Barbra Streisand Women's Heart Center, Smidt Cedars\u2010Sinai Heart Institute","place":["Los Angeles"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3257-3623","authenticated-orcid":false,"given":"Natalie","family":"Bello","sequence":"additional","affiliation":[{"name":"Barbra Streisand Women's Heart Center, Smidt Cedars\u2010Sinai Heart Institute","place":["Los Angeles"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9551-851X","authenticated-orcid":false,"given":"Janet","family":"Catov","sequence":"additional","affiliation":[{"name":"University of Pittsburg School of Medicine","place":["Pittsburgh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Licon","sequence":"additional","affiliation":[{"name":"University of California Irvine School of Medicine","place":["Irvine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9620-1402","authenticated-orcid":false,"given":"Abbi","family":"Lane","sequence":"additional","affiliation":[{"name":"University of South Carolina","place":["Columbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8379-0743","authenticated-orcid":false,"given":"David M.","family":"Haas","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine","place":["Indianapolis"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6811-7980","authenticated-orcid":false,"given":"Lisa D.","family":"Levine","sequence":"additional","affiliation":[{"name":"University of Pennsylvania School of 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