(935) Ethnic/Racial Differences in Pregnancy Outcomes for Patients Requiring Antepartum Antihypertensive Maintenance for Non-severe Hypertension.

This study aimed to determine differences in pregnancy outcomes and hypertension control for pregnant patients requiring antepartum antihypertensive maintenance across race/ethnicity groups.

Study Design: Patients who received prenatal care at an academic institution with a non-severe hypertensive disorder (chronic, gestational, preeclampsia) requiring oral antihypertensive maintenance medications were included. Medications had to be initiated prior to 34 weeks for a minimum of 2 weeks. Pregnancies with fetal anomalies and multiples were excluded. Patients were stratified by self-identified race/ethnicity. Hypertension outcomes included dosage changes and adherence, escalation in hypertension diagnosis (i.e. chronic to preeclampsia), and acute management of severe hypertension intrapartum. Pregnancy outcomes included mode of delivery, composite peripartum complications, GA at delivery, and BW. Statistics done with significance level of p < 0.05.

Results: 121 patients met inclusion criteria: 86 (71.1%) White, 16 (13.1%) Black, 6 (5.0%) Asian, and 10 (8.3%) Hispanic. Non-White patients experienced higher rates of antenatal dosage changes (80% v 55%, p=0.046), escalation in hypertensive diagnosis (64% v 38%, p=0.02), and need for acute antihypertensives intrapartum (42% v 21%, p=0.02) compared to White patients (Table 1). Black patients had higher rates of medically-indicated preterm delivery (69% v 36%, p=0.01), peripartum complications (31% vs 11%, p=0.04), and medication non-adherence (33% v 8%, p=0.01) compared to non-Black patients (Table 2). Asian patients had higher initial diastolic pressures upon delivery (99.5±26.1 v 85.8±13.9, p=0.03) compared to non-Asian patients. Hispanic patients were less likely to have cesarean delivery (30% v 64.9%, p=0.04) compared to all others.

Conclusion:

Non-White patients have a higher risk for inadequate blood pressure control, requiring more antihypertensive medication, along with greater difficulty with medication adherence. To optimize maternal outcomes equally across all racial/ethnic groups, understanding specific risks and needs remain paramount.