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875: Chronic hypertension and pregnancy: does race affect outcomes?
Poster Session V
ajog.org
Table 1 (data are %) White (n=6,378) Black (n=2,991) Hispanic (n=9,397) Asian (n=2,587) p-value
875 Chronic hypertension and pregnancy: does race affect outcomes? 1
2,3
1
Rachel A. Pilliod , Rebecca M. Reimers , Richard M. Burwick , Aaron B. Caughey1 1
Oregon Health and Science University, Portland, OR, 2Brigham and Women’s Hospital, Boston, MA, 3Massachusetts General Hospital, Boston, MA
OBJECTIVE: To estimate the effect of race on maternal and neonatal
outcomes in women with chronic hypertension. STUDY DESIGN: Retrospective cohort study of births linked to hospital discharge data for all singleton, non-anomalous pregnancies as recorded in a California Birth Certificate Database between 20052008. Women with chronic hypertension were identified by ICD-9 codes and stratified by White, Black, Hispanic and Asian race. Chisquared tests were used to compare dichotomous outcomes and multivariable logistic regression analyses were performed to control for potential confounders. RESULTS: We identified 2,039,870 pregnancies of which 21,959 (1.08%) were affected by chronic hypertension. Asian women were more likely to be of advanced maternal age. Insurance status, level of education, and nulliparous status were significantly different between the groups. Black women had the highest rates of limited prenatal care as defined by fewer than 5 prenatal visits. Asian and Hispanic women had higher rates of diabetes. Growth restriction and preterm birth rates were highest among Black women, though these women did not have the highest rates of oligohydramnios. Asian and Hispanic women also had higher rates of growth restriction, preterm birth and oligohydramnios than White women. The highest rates of preeclampsia were seen in Hispanic women, though Black women had the highest rates of abruption (Table 1). When controlling for maternal age, parity, college education, prenatal care, diabetes and gestational age, non-White race remained associated with oligohydramnios and growth restriction. Hispanic race remained associated with preeclampsia. (Figure 1) CONCLUSION: Adverse pregnancy outcomes associated with chronic hypertension manifest differently by maternal race. Modified preconception counseling, prenatal care and surveillance may be warranted to reflect these differences.
Nulliparous
44.2
29.8
28.4
39.7
Age > 35
37.8
37.0
35.8
51.6
0.0001 0.0001
Age <20
1.4
2.4
3.2
0.4
0.0001
Public Insurance
19.5
49.0
54.1
17.1
0.0001
Some College
70.0
53.8
32.3
80.7
0.0001
<5 Prenatal Visits 2.8
6.1
4.4
2.7
0.0001
Diabetes (DM)
4.5
7.1
9.7
8.0
0.0001
Gestational DM
15.7
14.6
23.7
28.0
0.0001
SGA <10%ile <5%ile <3%ile
8.2 4.0 2.6
14.6 8.2 5.9
11.0 5.9 4.2
14.3 7.2 4.5
0.0001 0.0001 0.0001
Oligohydramnios 4.4
6.0
5.5
6.2
0.001
Preterm Birth
26.9
24.3
23.8
0.0001
46.6
Birth <32 weeks
2.6
5.7
4.7
5.6
0.0001
Preeclampsia Severe Eclampsia
21.5 2.6 0.08
26.7 3.9 0.03
31.0 6.6 0.06
24.8 4.4 0.00
0.0001 0.0001 0.48
Abruption
1.5
2.4
2.0
2.2
0.01
876 Polyhydramnios: risk of mortality by each additional week of expectant management Rachel A. Pilliod1, Teresa Sparks2, Jessica Page3, Jonathan Snowden1, Yvonne W. Cheng4, Yvonne W. Cheng4, Aaron B. Caughey1 1
Oregon Health & Science University, Portland, OR, 2University of California, San Francisco, San Francisco, CA, 3University of Utah, Salt Lake City, UT, 4 California Pacific Medical Center, San Francisco, CA
OBJECTIVE: The objective of the study was to compare the fetal/infant
mortality risk associated with each additional week of expectant management with the mortality risk of immediate delivery in pregnancies affected by polyhydramnios. STUDY DESIGN: A retrospective cohort study was conducted of singleton, non-anomalous pregnancies from the 2005-2008 California Birth Registry with pregnancies affected and unaffected by polyhydramnios. Fetuses with oligohydramnios were excluded from analysis. We compared the risk of infant death at each week with a composite risk representing the mortality risk of one week of expectant management. RESULTS: We identified 1,852,291 pregnancies of which 6,773 (0.4%) were affected by polyhydramnios. The risk of IUFD in pregnancies affected by polyhydramnios was greater at every gestational age compared with unaffected pregnancies. The risk of fetal and infant mortality with expectant management is greater than the risk of infant death beginning at 39 weeks. CONCLUSION: The mortality risk of expectant management exceeds the risk of delivery at 39 weeks in pregnancies affected by polyhydramnios.
S500 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017
ajog.org
Table 1 (data are %) White (n=6,378) Black (n=2,991) Hispanic (n=9,397) Asian (n=2,587) p-value
875 Chronic hypertension and pregnancy: does race affect outcomes? 1
2,3
1
Rachel A. Pilliod , Rebecca M. Reimers , Richard M. Burwick , Aaron B. Caughey1 1
Oregon Health and Science University, Portland, OR, 2Brigham and Women’s Hospital, Boston, MA, 3Massachusetts General Hospital, Boston, MA
OBJECTIVE: To estimate the effect of race on maternal and neonatal
outcomes in women with chronic hypertension. STUDY DESIGN: Retrospective cohort study of births linked to hospital discharge data for all singleton, non-anomalous pregnancies as recorded in a California Birth Certificate Database between 20052008. Women with chronic hypertension were identified by ICD-9 codes and stratified by White, Black, Hispanic and Asian race. Chisquared tests were used to compare dichotomous outcomes and multivariable logistic regression analyses were performed to control for potential confounders. RESULTS: We identified 2,039,870 pregnancies of which 21,959 (1.08%) were affected by chronic hypertension. Asian women were more likely to be of advanced maternal age. Insurance status, level of education, and nulliparous status were significantly different between the groups. Black women had the highest rates of limited prenatal care as defined by fewer than 5 prenatal visits. Asian and Hispanic women had higher rates of diabetes. Growth restriction and preterm birth rates were highest among Black women, though these women did not have the highest rates of oligohydramnios. Asian and Hispanic women also had higher rates of growth restriction, preterm birth and oligohydramnios than White women. The highest rates of preeclampsia were seen in Hispanic women, though Black women had the highest rates of abruption (Table 1). When controlling for maternal age, parity, college education, prenatal care, diabetes and gestational age, non-White race remained associated with oligohydramnios and growth restriction. Hispanic race remained associated with preeclampsia. (Figure 1) CONCLUSION: Adverse pregnancy outcomes associated with chronic hypertension manifest differently by maternal race. Modified preconception counseling, prenatal care and surveillance may be warranted to reflect these differences.
Nulliparous
44.2
29.8
28.4
39.7
Age > 35
37.8
37.0
35.8
51.6
0.0001 0.0001
Age <20
1.4
2.4
3.2
0.4
0.0001
Public Insurance
19.5
49.0
54.1
17.1
0.0001
Some College
70.0
53.8
32.3
80.7
0.0001
<5 Prenatal Visits 2.8
6.1
4.4
2.7
0.0001
Diabetes (DM)
4.5
7.1
9.7
8.0
0.0001
Gestational DM
15.7
14.6
23.7
28.0
0.0001
SGA <10%ile <5%ile <3%ile
8.2 4.0 2.6
14.6 8.2 5.9
11.0 5.9 4.2
14.3 7.2 4.5
0.0001 0.0001 0.0001
Oligohydramnios 4.4
6.0
5.5
6.2
0.001
Preterm Birth
26.9
24.3
23.8
0.0001
46.6
Birth <32 weeks
2.6
5.7
4.7
5.6
0.0001
Preeclampsia Severe Eclampsia
21.5 2.6 0.08
26.7 3.9 0.03
31.0 6.6 0.06
24.8 4.4 0.00
0.0001 0.0001 0.48
Abruption
1.5
2.4
2.0
2.2
0.01
876 Polyhydramnios: risk of mortality by each additional week of expectant management Rachel A. Pilliod1, Teresa Sparks2, Jessica Page3, Jonathan Snowden1, Yvonne W. Cheng4, Yvonne W. Cheng4, Aaron B. Caughey1 1
Oregon Health & Science University, Portland, OR, 2University of California, San Francisco, San Francisco, CA, 3University of Utah, Salt Lake City, UT, 4 California Pacific Medical Center, San Francisco, CA
OBJECTIVE: The objective of the study was to compare the fetal/infant
mortality risk associated with each additional week of expectant management with the mortality risk of immediate delivery in pregnancies affected by polyhydramnios. STUDY DESIGN: A retrospective cohort study was conducted of singleton, non-anomalous pregnancies from the 2005-2008 California Birth Registry with pregnancies affected and unaffected by polyhydramnios. Fetuses with oligohydramnios were excluded from analysis. We compared the risk of infant death at each week with a composite risk representing the mortality risk of one week of expectant management. RESULTS: We identified 1,852,291 pregnancies of which 6,773 (0.4%) were affected by polyhydramnios. The risk of IUFD in pregnancies affected by polyhydramnios was greater at every gestational age compared with unaffected pregnancies. The risk of fetal and infant mortality with expectant management is greater than the risk of infant death beginning at 39 weeks. CONCLUSION: The mortality risk of expectant management exceeds the risk of delivery at 39 weeks in pregnancies affected by polyhydramnios.
S500 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017