Chronic Hypertension Is a Significant Predictor of Perinatal Mortality in High Risk African American Women in Washington DC

African American (AA) mothers have an increased likelihood of their pregnancy ending in a perinatal death. Causal factors are not fully understood. This study examines associations between demographic, biological and behavioral risk factors in pregnancy and perinatal mortality (20 weeks gestation up to 4 weeks postnatal deaths) in a population of AA mothers. An RCT testing the efficacy of a behavioral intervention to reduce risk was conducted in Washington DC. AA pregnant women were screened for eligibility and risk: women 18+ years old, exposed to smoking, environmental tobacco smoke, depression and intimate partner violence during pregnancy were recruited. Baseline and follow up data were collected by telephone interview during pregnancy and postpartum. Outcomes were collected by medical record review. Bivariate analysis was conducted using demographic, medical risk and behavioral risk data. Variables retained in a reduced model were those at p-value <0.15. In 887 pregnancies, 13 stillbirths, and 4 neonatal deaths occurred (Perinatal mortality rate of 19.5/1000 live births). Factors retained in the reduced model included education, active smoking, chronic hypertension and diabetes in pregnancy. In the logistic model only chronic hypertension retained significant association with perinatal mortality in this high risk population (OR=3.9, 95% C.I. = 1.1-13.4). In conclusion, chronic hypertension in AA women is a threat to their pregnancy with a significant association to perinatal mortality. AA women should be screened for chronic hypertension during the inter-conceptional period and in the first trimester for early diagnosis and treatment of this important reproductive health risk.