Health disparities in pregnancies complicated by acute-onset severe hypertension

Abstract

Objective

To examine health disparities in the management and clinical outcomes of singleton pregnancies diagnosed with acute-onset severe hypertension (AOSH) during hospitalization.

Study design

Retrospective cohort study (2016–2021) of pregnant patients with AOSH, defined as systolic blood pressure (SBP) ≥ 160 mmHg or diastolic blood pressure (DBP) ≥ 110 mmHg ≥ 15 min apart.

Main outcome measures

The primary outcome was timely therapy of AOSH, defined as correctly dosed first-line antihypertensive medication administered <60 min. Secondary outcomes were adverse maternal and perinatal composite outcomes. Multivariate logistic regression models were built to assess the association between patient factors, type of OBGYN practice, institutional factors, and the primary and secondary outcomes.

Results

Of the 732 patients, 298 (40.7 %) were non-Hispanic white, 297 (40.6 %) were non-Hispanic black, and 137 (18.7 %) were Hispanic. The primary outcome was not associated with race/ethnicity or other patient factors. The odds of timely emergent therapy of AOSH were 50 % higher in the 15:00 h–22:59 h nursing shift versus other shifts (aOR = 1.48; 95 % CI: 1.02, 2.18; P = 0.04). Furthermore, patients managed by private OBGYN physicians had significantly lower odds of adverse perinatal composite outcomes than those managed by academic OBGYN physicians (aOR = 0.39, 95 % CI: 0.21, 0.73; P = 0.003). Maternal adverse outcomes were not associated with any of the study factors.

Conclusion

Timely anti-hypertensive therapy for AOSH was not influenced by maternal race/ethnicity, language, or insurance status. However, timely therapy was more likely during the evening shift, and perinatal outcomes were better with private OBGYN practice.