Abstract
Background
Hypertensive disorders of pregnancy is one of the leading causes of adverse infant outcomes. Black women are disproportionately affected by hypertensive disorders of pregnancy, and it associated adverse outcomes. Adequate prenatal care may improve adverse infant outcomes. However, the evidence on adequate prenatal care improving birth outcomes for women with hypertensive disorders of pregnancy especially for Blacks is limited. This study examined the role of adequate prenatal care and race/ethnicity as moderators of hypertensive disorders of pregnancy on infant outcomes.
Methods
The sample was obtained from the 2016–2019 Pregnancy Risk Assessment Monitoring Surveillance dataset from North Carolina. We compared adequate prenatal care among women with hypertensive disorders of pregnancy (n = 610) to women without(n = 2,827), and women with hypertensive disorders of pregnancy with adequate prenatal care to women hypertensive disorders of pregnancy with inadequate prenatal care.
Results
The weighted prevalence of hypertensive disorders of pregnancy was 14.1%. Adequate prenatal care was associated with better infant outcomes for low birth weight (AOR = 0.72; 95% CI = 0.58, 0.90) and preterm birth (AOR = 0.62; 95% CI = 0.46, 0.82). Although these effects were not moderated by Black race/ethnicity, Black women independently also had worse outcomes for preterm birth (AOR = 1.59; 95% CI = 1.11, 2.28) and low birth weight (AOR = 1.81; 95% CI = 1.42, 2.29).
Conclusions
Moderation of hypertensive disorders of pregnancy effects on infant outcomes by prenatal care and race/ethnicity was not found. Women with hypertensive disorders of pregnancy who received inadequate prenatal care experienced worse adverse birth outcomes compared to women without hypertensive disorders of pregnancy. Strategies to improve prenatal care, particularly among underserved populations at risk for hypertensive disorders of pregnancy, need to be a public health priority.
Significance
What is already known on this subject? Racial/ethnicity disparities persist in birth outcomes in the United States despite the continuous efforts to improve birth outcomes.
What this study adds? Although, adequate prenatal care improves preterm birth, low birth weight, and small for gestational age, adequate prenatal care or race/ethnicity did not moderate adverse birth outcomes. Healthcare provider contacts during the pregnancy period may not be enough to address birth outcomes disparities. Preconception interventions should be encouraged, especially for Black women.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of Data and Material
Data available through the North Carolina Department of Health Statistics.
Code Availability
The statistical software used is described in the study.
References
Alexander, G. R., Kogan, M. D., Himes, J. H., Mor, J. M., & Goldenberg, R. (1999). Racial differences in birthweight for gestational age and infant mortality in extremely-low-risk US populations. Paediatric and Perinatal Epidemiology, 13(2), 205–217. https://doi.org/10.1046/J.1365-3016.1999.00174.X.
Alexander, G. R., & Kotelchuck, M. (2001). Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research. Public Health Reports, 116(4), 306. https://doi.org/10.1016/S0033-3549(04)50052-3.
Alhusen, J. L., Bower, K. M., Epstein, E., & Sharps, P. (2016). Racial discrimination and adverse birth outcomes: An integrative review. Journal of midwifery & women’s health, 61(6), 707–720. https://doi.org/10.1111/jmwh.12490.
Aris, I. M., Kleinman, K. P., Belfort, M. B., Kaimal, A., & Oken, E. (2019). A 2017 US reference for Singleton Birth Weight Percentiles using Obstetric estimates of Gestation. Pediatrics, 144(1), https://doi.org/10.1542/PEDS.2019-0076.
Barbosa, I. R. C., Silva, W. B. M., Cerqueira, G. S. G., Novo, N. F., Novo, J. L. V. G., & Almeida, F. A. (2015). Maternal and fetal outcome in women with hypertensive disorders of pregnancy: The impact of prenatal care. Therapeutic Advances in Cardiovascular Disease, 9(4), 140–146. https://doi.org/10.1177/1753944715597622.
Blencowe, H., Cousens, S., Oestergaard, M. Z., Chou, D., Moller, A. B., Narwal, R., Adler, A., Garcia, V., Rohde, C., Say, S., L., & Lawn, J. E. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. Lancet (London England), 379(9832), 2162–2172. https://doi.org/10.1016/S0140-6736(12)60820-4.
Brown, H. L., Warner, J. J., Gianos, E., Gulati, M., Hill, A. J., Hollier, L. M., Rosen, S. E., Rosser, M. L., & Wenger, N. K. (2018). Promoting risk identification and reduction of Cardiovascular Disease in women through collaboration with Obstetricians and Gynecologists: A Presidential Advisory from the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation, 137(24), e843–e852. https://doi.org/10.1161/CIR.0000000000000582.
Collier, A. R. Y., & Molina, R. L. (2019). Maternal mortality in the United States: Updates on Trends. Causes and Solutions NeoReviews, 20(10), e561–e574. https://doi.org/10.1542/NEO.20-10-E561.
Collins, J. W., & David, R. J. (2022). Black Babies Matter. Clinics in Perinatology, 49(1), 93–101. https://doi.org/10.1016/j.clp.2021.11.017.
Corrales-Gutierrez, I., Baena-Antequera, F., Gomez-Baya, D., Leon-Larios, F., & Mendoza, R. (2022). Relationship between eating Habits, physical activity and Tobacco and Alcohol Use in pregnant women: Sociodemographic Inequalities. Nutrients, 14(3), https://doi.org/10.3390/NU14030557.
Crandall, K. (2021). Pregnancy-related death disparities in non-hispanic black women. Women’s Health, 17, https://doi.org/10.1177/17455065211019888.
Ford, N. D., Cox, S., Ko, J. Y., Ouyang, L., Romero, L., Colarusso, T., Ferre, C. D., Kroelinger, C. D., Hayes, D. K., & Barfield, W. D. (2022). Hypertensive Disorders in pregnancy and mortality at delivery hospitalization — United States, 2017–2019. MMWR Morbidity and Mortality Weekly Report, 71(17), 585–591. https://doi.org/10.15585/MMWR.MM7117A1.
Fridman, M., Korst, L. M., Chow, J., Lawton, E., Mitchell, C., & Gregory, K. D. (2014). Trends in maternal morbidity before and during pregnancy in California. American Journal of Public Health, 104(Suppl 1), S49. https://doi.org/10.2105/AJPH.2013.301583.
Graubard, B. I., & Korn, E. L. (1996). Survey inference for subpopulations. American Journal of Epidemiology, 144(1), 102–106. https://doi.org/10.1093/OXFORDJOURNALS.AJE.A008847.
Hamadneh, S., & Hamadneh, J. (2021). Active and Passive maternal smoking during pregnancy and birth outcomes: A study from a developing country. Annals of Global Health, 87(1), https://doi.org/10.5334/AOGH.3384.
Kotelchuck, M. (1994). An evaluation of the Kessner adequacy of prenatal Care Index and a proposed adequacy of prenatal care utilization index. American Journal of Public Health, 84(9), 1414. https://doi.org/10.2105/AJPH.84.9.1414.
Lane-Cordova, A. D., Khan, S. S., Grobman, W. A., Greenland, P., & Shah, S. J. (2019). Long-Term Cardiovascular Risks Associated with adverse pregnancy outcomes: JACC Review topic of the Week. Journal of the American College of Cardiology, 73(16), 2106–2116. https://doi.org/10.1016/J.JACC.2018.12.092.
Luke, B., & Brown, M. B. (2007). Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Human Reproduction, 22(5), 1264–1272. https://doi.org/10.1093/HUMREP/DEL522.
Mehra, R., Keene, D. E., Kershaw, T. S., Ickovics, J. R., & Warren, J. L. (2019). Racial and ethnic disparities in adverse birth outcomes: Differences by racial residential segregation. SSM - Population Health, 8. https://doi.org/10.1016/J.SSMPH.2019.100417.
Muller, K. E., & Fetterman, B. A. (2003). Regression and ANOVA: an integrated approach using SAS software. 566.
Nasiri, K., Moodie, E. E. M., & Abenhaim, H. A. (2020). To what extent is the Association between Race/Ethnicity and fetal growth restriction explained by adequacy of prenatal care? A mediation analysis of a retrospectively selected cohort. American Journal of Epidemiology, 189(11), 1360–1368. https://doi.org/10.1093/AJE/KWAA054.
Osterman, M. J. K., & Martin, J. A. M. P. H. (2018). SystemTiming and adequacy of prenatal care in the United States, 2016. https://stacks.cdc.gov/view/cdc/55174
Parikh, N. I., Gonzalez, J. M., Anderson, C. A. M., Judd, S. E., Rexrode, K. M., Hlatky, M. A., Gunderson, E. P., Stuart, J. J., & Vaidya, D. (2021). Adverse pregnancy outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement from the American Heart Association. Circulation, 143(18), E902–E916. https://doi.org/10.1161/CIR.0000000000000961.
Rich-Edwards, J. W., Fraser, A., Lawlor, D. A., & Catov, J. M. (2014). Pregnancy characteristics and women’s future cardiovascular health: An underused opportunity to improve women’s health? Epidemiologic Reviews, 36(1), 57–70.
Sharma, G., Ying, W., & Vaught, A. J. (2020). Understanding the rural and racial disparities in Pre-Pregnancy Hypertension: Important considerations in maternal health equity. Journal of the American College of Cardiology, 76(22), https://doi.org/10.1016/J.JACC.2020.09.602.
Shin, D., & Song, W. O. (2019). Influence of the adequacy of the prenatal care utilization index on small-for-gestational-age infants and Preterm Births in the United States. Journal of Clinical Medicine, 8(6), https://doi.org/10.3390/JCM8060838.
Shulman, H. B., D’Angelo, D. V., Harrison, L., Smith, R. A., & Warner, L. (2018). The pregnancy risk Assessment Monitoring System (PRAMS): Overview of design and methodology. American Journal of Public Health, 108(10), 1305–1313. https://doi.org/10.2105/AJPH.2018.304563.
Shulman, H. B., Gilbert, B. C., & Lansky, A. (2006). The pregnancy risk Assessment Monitoring System (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121(1), 74. https://doi.org/10.1177/003335490612100114.
Walani, S. R. (2020). Global burden of preterm birth. International Journal of Gynecology & Obstetrics, 150(1), 31–33. https://doi.org/10.1002/IJGO.13195.
WHO (2016). WHO recommendations on antenatal care for a positive pregnancy experience. https://www.who.int/publications/i/item/9789241549912
Xaverius, P., Alman, C., Holtz, L., & Yarber, L. (2016). Risk factors Associated with very low Birth Weight in a large urban area, stratified by adequacy of prenatal care. Maternal and Child Health Journal, 20(3), 623–629. https://doi.org/10.1007/S10995-015-1861-4.
Yang, N., Collins, J. W., & Burris, H. H. (2021). States with more killings of unarmed black people have larger black-white preterm birth disparities. Journal of Perinatology: Official Journal of the California Perinatal Association, 41(2), 358–359. https://doi.org/10.1038/S41372-020-00914-6.
Yeo, S., Crandell, J. L., & Jones-Vessey, K. (2016). Adequacy of prenatal care and Gestational Weight Gain. Journal of Women’s Health (2002), 25(2), https://doi.org/10.1089/JWH.2015.5468.
Acknowledgements
We acknowledge the North Carolina Department of Health Statistics, North Carolina PRAMS Working Group and the Centers for Disease Control and Prevention for providing the data for the study and the Duke University School of Nursing, which supported this work. This work was completed, in part, to meet the dissertation requirements for the PhD of the first author.
Funding
No direct funding for this research project.
Author information
Authors and Affiliations
Contributions
FA-conceived of the original idea and writing of the manuscript, TM, analyses of the data and writing of the manuscript, SS, analyses and writing of the results, JA and YS, guided on the original idea and writing of the manuscript, EM and DHD oversaw the overall direction of the manuscript.
Corresponding author
Ethics declarations
Competing interests
All authors report no conflicts of interest.
Ethical approval
“For this type of study formal consent is not required.”
Informed Consent
Data used in this study was obtained from the North Carolina Department of Health Statistics. “For this type of study formal consent is not required.”
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Avorgbedor, F., McCoy, T.P., Silva, S. et al. Infant Outcomes in Hypertensive Women: Are there Moderating Effects of Prenatal Care and Race/Ethnicity?. Matern Child Health J 27, 1277–1283 (2023). https://doi.org/10.1007/s10995-023-03661-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-023-03661-0