Association of diabetes, eclampsia, BMI, hypertension and behavioral risks with poor pregnancy outcomes among high risk African Americans (AAs) in Washington, DC

The relationship between diabetes, eclampsia, Body Mass Index (BMI), hypertension and behavioral risks (smoking, environmental tobacco smoke, depression, intimate partner violence (IPV)), and adverse pregnancy outcomes (low birthweight (LBW), preterm births (PTB) and large-for-gestational-age (LGA)) in high risk AAs in Washington, DC was investigated. 1044 pregnant AAs were enrolled and interviewed at baseline, 2nd, and 3rd trimester. Birthweight and gestational age were abstracted from medical records. Classification and Regression Trees (CART) was used. Women were more likely to have LBW (<2,500 grams) babies if diagnosed with: eclampsia (OR=3.13,p=0.002), preconception diabetes & no gestational hypertension (OR=3.14,p=0.018), and smoking, preconception diabetes & no gestational hypertension (OR=1.76,p=0.037). Women were more likely to have PTB (<37 weeks gestation) if diagnosed with: eclampsia and no preconception diabetes (OR=2.47,p=0.031), preconception diabetes (OR=3.93,p=0.002), chronic hypertension, no preconception diabetes & no IPV (OR=2.63,p=0.74), or IPV & no preconception diabetes (OR=1.55,p=0.058). LGA (>90th percentile) was more likely for those diagnosed with: preconception diabetes (OR=5.22,p<0.001), gestational diabetes & not smoking (OR=2.70,p=0.180). Eclampsia and BMI were most important predictors of LBW, followed by gestational hypertension, education & preconception diabetes. For very LBW (<1,500 grams) babies, BMI & gestational diabetes were most important predictors. For PTB and very PTB (<34 weeks gestation) and LGA, BMI was the most important predictor. BMI and eclampsia, followed by preconception diabetes and IPV were the most important predictors of PTB and very PTB. Screening not only for medical but also for behavioral risks should receive high priority. This will increase maternal survival and improve pregnancy outcomes.