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Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 6, pp 1182–1191 | Cite as

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

  • Kharah M. RossEmail author
  • Christine Dunkel Schetter
  • Monica R. McLemore
  • Brittany D. Chambers
  • Randi A. Paynter
  • Rebecca Baer
  • Sky K. Feuer
  • Elena Flowers
  • Deborah Karasek
  • Matthew Pantell
  • Aric A. Prather
  • Kelli Ryckman
  • Laura Jelliffe-Pawlowski
Article

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.

Keywords

Health disparities Socioeconomic status Race/ethnicity Preeclampsia Gestational length 

Notes

Acknowledgments

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

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

40615_2019_619_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21 kb)

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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  • Kharah M. Ross
    • 1
    Email author
  • Christine Dunkel Schetter
    • 2
  • Monica R. McLemore
    • 3
  • Brittany D. Chambers
    • 4
    • 5
  • Randi A. Paynter
    • 4
  • Rebecca Baer
    • 4
    • 6
  • Sky K. Feuer
    • 4
    • 7
  • Elena Flowers
    • 8
  • Deborah Karasek
    • 4
    • 7
  • Matthew Pantell
    • 9
  • Aric A. Prather
    • 10
  • Kelli Ryckman
    • 11
  • Laura Jelliffe-Pawlowski
    • 4
    • 5
  1. 1.Owerko Centre, Alberta Children’s Hospital Research InstituteUniversity of CalgaryCalgaryCanada
  2. 2.Department of PsychologyUniversity of California Los AngelesLos AngelesUSA
  3. 3.Department of Family Health Care NursingUniversity of California San FranciscoSan FranciscoUSA
  4. 4.California Preterm Birth InitiativeUniversity of California San FranciscoSan FranciscoUSA
  5. 5.Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoUSA
  6. 6.Department of PediatricsUniversity of California San DiegoSan DiegoUSA
  7. 7.Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California San Francisco School of MedicineSan FranciscoUSA
  8. 8.Department of Physiological NursingUniversity of California San FranciscoSan FranciscoUSA
  9. 9.Department of PediatricsUniversity of California San FranciscoSan FranciscoUSA
  10. 10.Department of PsychiatryUniversity of California San FranciscoSan FranciscoUSA
  11. 11.Department of EpidemiologyUniversity of IowaIowa CityUSA

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