Maternal and Child Health Journal

, Volume 10, Issue 1, pp 39–46 | Cite as

Maternal Hypertension as a Risk Factor for Low Birth Weight Infants: Comparison of Haitian and African-American Women

  • Christine D. Odell
  • Milton Kotelchuck
  • V. K. Chetty
  • Josephine Fowler
  • Phillip G. Stubblefield
  • Malena Orejuela
  • Brian W. Jack

Background: The rate of low birth weight (LBW) of Black women is more than twice that of White women. This study explores if the rate of LBW differs between Haitian and African-American women with chronic hypertension. Methods: A retrospective cohort study of all Black women self-identified as African-American (n = 12,258) or Haitian (n = 4320) delivering a singleton infant in Massachusetts between 1996 and 2000. Results: Haitian women were more likely than African-American women to have chronic hypertension (2.7% vs. 2.1%, p = 0.006), but had similar rates of preeclampsia (3.1% vs. 3.3%, p = 0.27). The LBW rate was 10% among African-American women and 8.2% among Haitian women. After adjustment for sociodemographic, medical, and prenatal care characteristics, the greatest risks for delivering a LBW infant for Haitian women were chronic hypertension (OR = 6.8; 95% CI, 4.3, 10.6) and preeclampsia (OR = 3.2; 95% CI, 2.0, 5.1). For African-American women, the greatest risks for LBW infants were a history of delivering a LBW infant (OR = 3.9; 95% CI, 2.8, 5.4) and chronic hypertension (OR = 2.9; 95% CI, 2.1, 4.0). In a combined logistic regression model including interaction terms, chronic hypertension and preeclampsia continued to be associated with the greatest risk of LBW among all women. Conclusions: Differences in maternal risk factors and rates of LBW (8.2% vs. 10%) exist between Haitian and African-American women delivering infants in Massachusetts. While chronic hypertension and preeclampsia are strong risk factors for LBW for both Haitian and African-American women, unknown factors make these disorders much more potent for Haitian women.


Low birth weight maternal hypertension racial disparities. 


  1. 1.
    Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: Confronting racial and ethnic disparities in health care (2003) Committee on understanding and eliminating racial and ethnic disparities in health care. Washington, DC.: Institute of Medicine, National Academy of Science, National Academies Press, 2001.Google Scholar
  2. 2.
    Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Final Data for 2002. National Vital Statistics Reports, Vol. 52, No. 10. Hyattsville MD: National Center for Health Statistics, 2003.Google Scholar
  3. 3.
    U.S. Department of Health and Human Services. Healthy people 2010: Understanding and improving health (2nd ed.). Washington, DC: U.S. Government Printing Office, November 2000.Google Scholar
  4. 4.
    Prineas RJ, Gillum RF. US epidemiology of hypertension in Blacks. In: Hall WD, Saunders E, Shulman NB, Eds. Hypertension in Blacks: Epidemiology, pathophysiology and treatment. Chicago, IL: Year Book Medical Publishers, Inc; 1985:17–37.Google Scholar
  5. 5.
    Cooper R, Rotimi C, Ataman S, McGee D, Osotimehin B, Kadiri S, Muna W, Kingue S, Fraser H, Forrester T, Bennett F, Wilks R. The prevalence of hypertension in seven populations of West African Origin. Am J Public Health 1997;87:160–8.PubMedGoogle Scholar
  6. 6.
    Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002;100:369–77.Google Scholar
  7. 7.
    Jain L. Effect of pregnancy-induced and chronic hypertension on pregnancy outcome. J Perinatol 1997;17:425–7.PubMedGoogle Scholar
  8. 8.
    Samadi AR, Mayberry RM, Zaidi AA, Pleasant JC, McGhee N, Jr., Rice RJ. Maternal hypertension and associated pregnancy complications among African-American and other women in the United States. Obstet Gynecol 1996;87:557–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Pallotto EK, Collins JW, Jr., David RJ. Enigma of maternal race and infant birth weight: A population-based study of US-born Black and Caribbean-born Black women. Am J Epidemiol 2000;151:1080–5.PubMedGoogle Scholar
  10. 10.
    Fang J, Madhavan S, Alderman MH. The influence of maternal hypertension on low birth weight: Differences among ethnic populations. Ethn Dis 1999;9:369–76.PubMedGoogle Scholar
  11. 11.
    Rey E. Preeclampsia and neonatal outcomes in chronic hypertension: Comparison between white and Black women. Ethn Dis 1997;7:5–11.PubMedGoogle Scholar
  12. 12.
    Friedman DJ, Cohen BB, Mahan CM, Lederman RI, Vezina RJ, Dunn VH. Maternal ethnicity and birthweight among Blacks. Ethn Dis. 1993;3:255–69.PubMedGoogle Scholar
  13. 13.
    David RJ, Collins JW, Jr. Differing birth weight among infants of U.S.-born blacks, African-born blacks and U.S.-born whites. New England Journal of Medicine 1997;337:1209–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Births to Black Mothers in Massachusetts: 1997–2000. The Commonwealth of Massachusetts, Executive Office of Health and Human Services, Department of Public Health. December, 2002.Google Scholar
  15. 15.
    Kogan MD, Alexander GR, Kotelchuck M, Nagey DA. Relation of the content of prenatal care to the risk of low birth weight. JAMA 1994;271:1340–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Hessol NA, Feuntes-Afflick E, Bacchetti P. Risk of low birth weight infants among Black and white parents. Obstet Gynecol 1998;92:814–22.CrossRefPubMedGoogle Scholar
  17. 17.
    Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 1994;84:1414–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Wright JT, Rahman M, Scarpa A, Fatholahi M, Griffin V, Jean-Baptiste R, Islam M, Eissa M, White S, Douglas JG. Determinants of salt sensitivity in black and white normotensive and hypertensive women. Hypertension 2003;42:1087–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Engerman SL, Inkori JE, Eds. The Atlantic Slave Trade: Effects on Economies, Societies, and Peoples in Africa, the Americas, and Europe. Duke University Press. Durham, NC, 1992;339–54.Google Scholar
  20. 20.
    Rich-Edwards J, Krieger N, Majzoub J, Zierler S, Lieberman E, Gillman M. Maternal experiences of racism and violence as predictors of preterm birth: rationale and study design. Paediat Perinatal Epidemiol 2001;15(Suppl. 2):124–35.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Christine D. Odell
    • 1
    • 2
  • Milton Kotelchuck
    • 2
  • V. K. Chetty
    • 1
  • Josephine Fowler
    • 1
    • 2
  • Phillip G. Stubblefield
    • 2
    • 3
  • Malena Orejuela
    • 4
  • Brian W. Jack
    • 1
    • 5
  1. 1.Department of Family MedicineBoston Medical Center/Boston University School of MedicineBoston,Massachusetts
  2. 2.Department of Maternal and Child HealthBoston University School of Public HealthBoston,Massachusetts
  3. 3.Department of Obstetrics and GynecologyBoston Medical Center/Boston University School of MedicineBoston,Massachusetts
  4. 4.Massachusetts Department of Public HealthBoston,Massachusetts
  5. 5.Boston Medical Center, Dowling 5 South, 1 BMC PlaceBoston,Massachusetts

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