New research reveals significant disparities in pregnancy-related high blood pressure risks among different Asian American, Native Hawaiian and Pacific Islander subgroups, with Pacific Islander and Filipino individuals facing substantially higher risks than other groups. The findings, published in the Journal of the American Heart Association, emphasize the importance of moving beyond broad racial categories to understand specific health risks within diverse populations.
The study analyzed California health records from 2007-2019 for 772,688 pregnant individuals who self-identified as Asian American, Native Hawaiian or Pacific Islander, divided into 15 subgroups. Researchers examined five hypertensive disorders of pregnancy: chronic hypertension, gestational hypertension, preeclampsia, eclampsia and chronic hypertension with preeclampsia. Pregnancy-related high blood pressure increases the risk of heart attack and stroke and is one of the leading causes of maternal illness and death, according to the U.S. Centers for Disease Control and Prevention.
The analysis found the lowest frequency of pregnancy-related high blood pressure in the Chinese subgroup at 3.7%, while the Guamanian subgroup had the highest frequency at 13%. Using the Chinese population as reference, the risk of pregnancy-related high blood pressure conditions was elevated two to three times higher among Filipino and Pacific Islander populations, including Hawaiian, Guamanian, Samoan and other Pacific Islander individuals, after adjusting for sociodemographic and maternal-health factors. Only Japanese, Korean and Vietnamese individuals tended to have risks that were not elevated compared to the Chinese reference group.
"There are known ways to help prevent and treat high blood pressure during pregnancy. Our findings can help health care professionals identify those who are at higher risk," said study lead author Jennifer Soh, M.S., who conducted the research while in the Community Health and Prevention Research Program at Stanford University School of Medicine. "Early identification and treatment can help prevent serious, downstream complications for both the pregnant individuals and their infants."
Previous research has indicated that the risk of developing pregnancy-related high blood pressure differs among people of different races and ethnicities due to social determinants of health. However, little was known about differences in risk between Asian American, Native Hawaiian and Pacific Islander populations as they are often studied together, despite the diversity found within these groups. The American Heart Association notes these conditions can be managed and treated with medication or lifestyle changes, and provides health information about pregnancy and maternal health at https://www.heart.org/en/health-topics/high-blood-pressure/pregnancy-and-high-blood-pressure.
The study had several limitations, including reliance on medical diagnostic codes that may be subject to underreporting or misclassification, and data limited to California residents, meaning results may not apply to other communities. The research also could not account for the effects of the COVID-19 pandemic or consider additional potential factors that may impact high blood pressure during pregnancy, such as air pollution, neighborhood walkability and food access.
"The observed racial-ethnic differences in risk highlight the variation in lived experiences of the individuals included in this study," Soh said. "Future studies should examine more structural and social factors that could help explain the differences in the elevated risks found in this study." The findings underscore the need for healthcare providers to consider specific ethnic backgrounds rather than broad racial categories when assessing pregnancy risks and developing prevention strategies.
