Pre-eclampsia in American Indians/Alaska Natives and Whites: The Significance of Body Mass Index
- 227 Downloads
Introduction The prevalence of pre-eclampsia, a major cause of maternal morbidity, varies by race, being greater in African Americans, and lower in Asians and Hispanics than in White women. Little is known about its prevalence in American Indians/Alaska Natives (AI/ANs). We estimated pre-eclampsia risk in AI/ANs compared to Whites, with consideration of the potential effect of obesity, a major risk factor for pre-eclampsia, and a condition disproportionately affecting AI/AN women. Methods This retrospective cohort study of linked birth-hospital discharge data from Washington State (2003–2013) included all AI/AN women and a sample of White first-time mothers with singleton deliveries. Logistic regression was used to estimate odds ratio (OR) and 95 % confidence intervals (CI) for pre-eclampsia risk in AI/ANs compared to Whites, first controlling for several important risk factors, and subsequently with additional adjustment for pre-pregnancy body mass index (BMI). Results AI/ANs had an increased risk of pre-eclampsia compared to Whites after controlling for all covariates except BMI (OR 1.17, 95 % CI 1.06–1.29). After further adjustment for BMI, the racial disparity in pre-eclampsia risk was greatly attenuated (OR 1.05, 95 % CI 0.95–1.16). Discussion This population-based study suggests that any increased risk in AI/ANs relative to Whites may be at least partly due to differences in BMI.
KeywordsPre-eclampsia Body mass index Overweight Obesity American Indian/Alaska Native Health disparities
We would like to thank the Washington State Department of Health for allowing us to access the data, Bill O’Brien for his technical support, and Raymond Harris for his assistance writing the manuscript.
Support for this research was provided by funding from the National Institute of Mental Health (T32 MH082709, K. Comtois, PI).
Compliance with Ethical Standards
Conflict of Interest
All authors declare that they have no conflict of interest.
- Baldwin, L. M., Grossman, D. C., Murowchick, E., Larson, E. H., Hollow, W. B., Sugarman, J. R., et al. (2009). Trends in perinatal and infant health disparities between rural American Indians and Alaska natives and rural Whites. American Journal of Public Health, 99(4), 638–646.CrossRefPubMedPubMedCentralGoogle Scholar
- CDC. (2001). Pregnancy-related deaths among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women—United States, 1991–1997. MMWR Morbidity and Mortality Weekly Report, 50(18), 361–364.Google Scholar
- CDC. (2012). Survey health statistics for US adults: National health interview survey, 2011. US Department of Health and Human Services, 10(256). http://www.cdc.gov/nchs/data/series/sr_10/sr_256.pdf.
- Lydon-Rochelle, M. T., Holt, V. L., Cardenas, V., Nelson, J. C., Easterling, T. R., Gardella, C., et al. (2005a). The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. American Journal of Obstetrics and Gynecology, 193(1), 125–134.CrossRefPubMedGoogle Scholar
- Lydon-Rochelle, M. T., Holt, V. L., Nelson, J. C., Cardenas, V., Gardella, C., Easterling, T. R., et al. (2005b). Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records. Paediatric and Perinatal Epidemiology, 19(6), 460–471.CrossRefPubMedGoogle Scholar
- StataCorp. (2013). Stata statisttical software: Release 13. College Station, TX: StataCorp, LP.Google Scholar