197085 Outcomes of chronic hypertension in pregnancy: Origins of health disparities

Tuesday, November 10, 2009: 5:30 PM

Renaisa S. Anthony, MD, MPH , Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE
Amelia J. Cobb, MPH , George Washington University School of Public Health and Health Services, Washington, DC
Michele Kiely, DrPH , Division of Epidemiology, Statistics & Prevention Research, National Institute of Child Health and Human Development/NIH, Rockville, MD
Ayman El Mohandes, MBBCh, MD, MPH , Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, DC
  
Hypertension and its complications in African Americans (AA) remain an important public health challenge. Chronic hypertension (cHTN) in pregnant AA is an even more complex issue impacting both the mother and fetus. The risk of cHTN during pregnancy is 2-3Xs higher for AA contributing to significantly higher rates of preeclampsia (PE), preterm birth (PTB) and infant and maternal morbidity/mortality. In the District of Columbia, AA suffer from one of the highest maternal (22/100,000) and infant mortality rates (17/10,000) in the nation secondary to complications of cHTN including PE and PTB. Limited data exist to explain such health disparities associated with poor maternal and fetal outcomes.

The Outcomes of Chronic Hypertension in Pregnancy is a prospective cohort study designed to identify health disparities that contribute to poor maternal and fetal outcomes. The study uses a multi-factorial approach to recruit 300 (50% AA and 50% C) pregnant women with cHTN to assess biological, psychosocial, and behavioral characteristics including (a) access and compliance to care, (b) knowledge of cHTN and its complications (c) lifestyle choices including diet and exercise (d) depression and social support and (e) maternal/fetal outcomes. Additionally, serial measurements of sFlt (a preeclampsia biomarker) will allow for comparison of disease pathogenesis by racial group and could result in development of a preeclampsia screening tool facilitating early diagnosis.

This study will have significant public health implications by understanding contributors to health disparities, informing recommendations for optimizing prenatal care, and strengthening future interventions to improve pregnancy outcomes for AA women and their infants.

Learning Objectives:
1. Describe pregnancy outcome disparities that exist between African American and Caucasian pregnant women with chronic hypertension (cHTN); 2. Explain the connection between cHTN, preeclampsia, preterm birth, and infant and maternal morbidity and mortality; 3. Identify potential psychosocial and behavioral risk factors that contribute to pregnancy outcome disparities and poor maternal and fetal outcomes; 4. Discuss the role of serum fms like tyrosine kinase (sFlt) as a preeclampsia biomarker for the development of a preeclampsia screening tool for early preeclampsia diagnosis; 5. Discuss background, methodology, and implementation of an investigative research study to identify health disparities that contribute to poor maternal and fetal outcomes; and 6. Identify potential public health interventions to improve pregnancy outcomes for high risk women with cHTN.

Keywords: Pregnancy Outcomes, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I serve as the Principle Investigator on the NIH supported Outcomes of Chronic Hypertension in Pregnancy: Origins of Health Disparies Study. I am appointed as an assistant research professor with expertise in women's health and health disparities at the George Washington University School of Public Health and Health Services in the Department of Prevention and Community Health. My previous research, publications, and training in women's health make me a qualified abstract author for this content.
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.

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