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Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women

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Abstract

Background

Higher socioeconomic status (SES) has less impact on cardio-metabolic disease and preterm birth risk among Black women compared to White women, an effect called “diminishing returns.” No studies have tested whether this also occurs for pregnancy cardio-metabolic disease, specifically preeclampsia, or whether preeclampsia risk could account for race-by-SES disparities in birth timing.

Methods

A sample of 718,604 Black and White women was drawn from a population-based California cohort of singleton births. Education, public health insurance status, gestational length, and preeclampsia diagnosis were extracted from a State-maintained birth cohort database. Age, prenatal care, diabetes diagnosis, smoking during pregnancy, and pre-pregnancy body mass index were covariates.

Results

In logistic regression models predicting preeclampsia risk, the race-by-SES interaction (for both education and insurance status) was significant. White women were at lower risk for preeclampsia, and higher SES further reduced risk. Black women were at higher risk for preeclampsia, and SES did not attenuate risk. In pathway analyses predicting gestational length, an indirect effect of the race-by-SES interaction was observed. Among White women, higher SES predicted lower preeclampsia risk, which in turn predicted longer gestation. The same was not observed for Black women.

Conclusions

Compared to White women, Black women had increased preeclampsia risk. Higher SES attenuated risk for preeclampsia among White women, but not for Black women. Similarly, higher SES indirectly predicted longer gestational length via reduced preeclampsia risk among White women, but not for Black women. These findings are consistent with diminishing returns of higher SES for Black women with respect to preeclampsia.

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Notes

  1. Both White and Black categories include women born in and outside the USA.

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Acknowledgments

This project was supported by University of California San Francisco California Preterm Birth Initiative.

Author information

Authors and Affiliations

  1. Owerko Centre, Alberta Children’s Hospital Research Institute, University of Calgary, #355, 3820 24th Ave, Calgary, AB, T3B 2X9, Canada

    Kharah M. Ross

  2. Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA

    Christine Dunkel Schetter

  3. Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA

    Monica R. McLemore

  4. California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA

    Brittany D. Chambers, Randi A. Paynter, Rebecca Baer, Sky K. Feuer, Deborah Karasek & Laura Jelliffe-Pawlowski

  5. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Brittany D. Chambers & Laura Jelliffe-Pawlowski

  6. Department of Pediatrics, University of California San Diego, San Diego, CA, USA

    Rebecca Baer

  7. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA

    Sky K. Feuer & Deborah Karasek

  8. Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA

    Elena Flowers

  9. Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA

    Matthew Pantell

  10. Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA

    Aric A. Prather

  11. Department of Epidemiology, University of Iowa, Iowa City, IA, USA

    Kelli Ryckman

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  1. Kharah M. Ross
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Correspondence to Kharah M. Ross.

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Ross, K.M., Dunkel Schetter, C., McLemore, M.R. et al. Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women. J. Racial and Ethnic Health Disparities 6, 1182–1191 (2019). https://doi.org/10.1007/s40615-019-00619-3

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