194729 Chronic Hypertension Is a Significant Predictor of Perinatal Mortality in High Risk African American Women in Washington DC

Tuesday, November 10, 2009: 11:05 AM

Ayman El-Mohandes, MD, MBBCh, MPH , College of Public Health, University of Nebraska Medical Center, Omaha, NE
M. Nabil El-Khorazaty, PhD , Statistics and Epidemiology Unit, RTI International, Rockville, MD
Michele Kiely, DrPH , Division of Epidemiology, Statistics & Prevention Research, National Institute of Child Health and Human Development/NIH, Rockville, MD
Marie Gantz, PhD , Statistics and Epidemiology Unit, RTI International, Rockville, MD
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.

Learning Objectives:
1. Identify perinatal mortality and stillbirth as an important contributor to health disparities. 2. Differentiate the role that various risk factors during pregnancy may play in increasing the susceptibility of African American women in suffering from a perinatal loss. 3. Evaluate the importance of chronic hypertension in African American women in contributing towards perinatal death and approaches towards reducing its impact on negative reproductive outcomes.

Keywords: Perinatal Outcomes, African American

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Not applicable

Qualified on the content I am responsible for because: I am qualified to be an author on the content of this abstract as a Principal Investigator on the NIH grant for the study under which the data were collected and analyzed.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.