Research published in the Journal of the American Heart Association reveals significant disparities in pregnancy-related high blood pressure risk among Asian American, Native Hawaiian and Pacific Islander subgroups. The study, which analyzed California health records from 2007-2019, found that Pacific Islander and Filipino individuals face two to three times higher risk than Chinese individuals, after adjusting for sociodemographic and maternal-health factors.
The analysis examined 772,688 pregnant individuals who self-identified as Asian American, Native Hawaiian or Pacific Islander, divided into 15 subgroups. Researchers found the lowest frequency of pregnancy-related high blood pressure in the Chinese subgroup at 3.7%, while the Guamanian subgroup had the highest frequency at 13%. Only Japanese, Korean and Vietnamese individuals tended to have risks that were not elevated compared to the Chinese reference group.
Pregnancy-related high blood pressure increases the risk of heart attack and stroke and is one of the leading causes of maternal illness and death, according to the U.S. Centers for Disease Control and Prevention. In the United States, about 1 in 7 pregnancies are affected by a high blood pressure-related condition during pregnancy. These conditions can be managed and treated with medication or lifestyle changes, according to the American Heart Association.
"There are known ways to help prevent and treat high blood pressure during pregnancy. Our findings can help health care professionals identify those who are at higher risk," said study lead author Jennifer Soh, M.S., who conducted the research while at Stanford University School of Medicine. "Early identification and treatment can help prevent serious, downstream complications for both the pregnant individuals and their infants."
The study examined five hypertensive disorders of pregnancy: chronic hypertension, gestational hypertension, preeclampsia, eclampsia and chronic hypertension with preeclampsia. Preeclampsia is high blood pressure during pregnancy characterized by too much protein in the urine or other signs of organ damage, while eclampsia is a serious complication that can cause seizures.
Previous research has indicated that the risk of developing pregnancy-related high blood pressure differs among people of different races and ethnicities due to social determinants of health. However, little has been known about differences in risk between Asian American, Native Hawaiian and Pacific Islander populations as they are often studied together, despite the diversity found within these groups.
"The observed racial-ethnic differences in risk highlight the variation in lived experiences of the individuals included in this study," Soh said. "Future studies should examine more structural and social factors that could help explain the differences in the elevated risks found in this study."
The study had several limitations, including reliance on medical diagnostic codes that may be subject to underreporting or misclassification, and data limited to California residents. The research also could not account for additional potential factors that may impact high blood pressure during pregnancy, such as air pollution, neighborhood walkability and food access. The study period ended before the COVID-19 pandemic began, so researchers could not assess its effects.
For business and technology leaders in healthcare, these findings underscore the importance of developing more nuanced, data-driven approaches to maternal health that account for significant variations within broader racial and ethnic categories. The research suggests that blanket approaches to Asian and Pacific Islander populations may overlook critical risk disparities, potentially affecting healthcare outcomes and resource allocation.
The American Heart Association provides comprehensive health information on pregnancy and maternal health through its resources. Studies published in the Association's scientific journals are peer-reviewed, and the statements and conclusions in each manuscript are solely those of the study authors. The Association receives more than 85% of its revenue from sources other than corporations, including contributions from individuals, foundations and estates, as well as investment earnings and revenue from educational materials sales. Overall financial information is available at https://www.heart.org/en/about-us/aha-financial-information.
