The Role of Race in Pregnancy, Hypertension, and Long-Term Outcomes

This review aims to discuss racial and ethnic differences in the prevalence of hypertensive disorders of pregnancy (HDP), disparities in peripartum and postpartum outcomes, and strategies to improve health equity.

Racial disparities in HDP are significant contributors to maternal morbidity and mortality. The prevalence of preeclampsia has increased over the last 20 years, with the highest prevalence among non-Hispanic Black, non-Hispanic American Indian and Alaska Native individuals. Black birthing individuals are at increased risk for cardiovascular-related morbidity and mortality, particularly from complications of HDP. Factors such as social determinants of health and systemic racism have a significant impact on disparities in maternal and fetal outcomes related to HDP.

System changes and provider implicit bias training can help address systemic racism. Interventions aimed at improving access to care, such as telehealth and home blood pressure monitoring, as well as incorporating health system navigators that provide peripartum and postpartum support can improve outcomes and promote health equity.