Effect of Parity on Pregnancy-Associated Hypertension Among Asian American Women in the United States

Abstract

Objectives

Pregnancy-associated hypertension (PAH) includes gestational hypertension, preeclampsia and eclampsia. Although a protective effect of multi-parity on PAH has been reported in previous studies, the association has not been examined among Asian American women in the U.S.

Methods

Using data from 2014 U.S. National Vital Statistics System, we examined the prevalence of PAH among Asian American women who had singleton live births (N = 235,303), and its association with parity (number of previous pregnancies including live births and fetal deaths) controlling for potential confounders. We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CI) using multivariable logistic regression analysis.

Results

Overall, 2.72% (95% CI 2.66%, 2.79%) of Asian American women were recorded to have PAH during pregnancy. Parity was inversely associated with PAH in our study, where Asian American women who had 1–2 and 3 or more previous pregnancies had significantly lower odds of PAH (aOR 0.61, 95% CI 0.58, 0.65; and aOR 0.62, 95% CI 0.57, 0.68, respectively) compared to nulliparous women, after controlling for potential confounders.

Conclusions

Recent U.S. vital statistics data revealed that nulliparity is significantly associated with PAH among Asian American women. Future studies should identify specific factors that are associated with PAH and factors contributing to disparities in PAH risk among Asian American women.

This is a preview of subscription content, log in to check access.

References

  1. Ananth, C. V., Wilcox, A. J., Savitz, D. A., Bowes, W. A., & Luther, E. R. (1996). Effect of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy. Obstetrics and Gynecology, 88(4 Pt 1), 511–516.

    Article  CAS  PubMed  Google Scholar 

  2. Ayala, D. E., & Hermida, R. C. (2001). Influence of parity and age on ambulatory monitored blood pressure during pregnancy. Hypertension, 38(3 Pt 2), 753–758.

    Article  CAS  PubMed  Google Scholar 

  3. Bai, J., Wong, F. W., Bauman, A., & Mohsin, M. (2002). Parity and pregnancy outcomes. American Journal of Obstetrics and Gynecology, 186(2), 274–278.

    Article  PubMed  Google Scholar 

  4. CDC WONDER. (2019). Retrieved from https://wonder.cdc.gov/

  5. Duckitt, K., & Harrington, D. (2005). Risk factors for pre-eclampsia at antenatal booking: Systematic review of controlled studies. BMJ, 330(7491), 565. https://doi.org/10.1136/bmj.38380.674340.E0.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Franco, R. C., Ferreira, C. R., Vieira, C. R., & Silva, R. R. (2015). Ethnicity, obesity and emotional factors associated with gestational hypertension. Journal of Community Health, 40(5), 899–904. https://doi.org/10.1007/s10900-015-0010-8.

    Article  PubMed  Google Scholar 

  7. Fuchs, K., Peretz, B. A., Marcovici, R., Paldi, E., & Timor-Tritsh, I. (1985). The “grand multipara”–is it a problem? A review of 5785 cases. International Journal of Gynaecology and Obstetrics, 23(4), 321–326.

    Article  CAS  PubMed  Google Scholar 

  8. Giubertoni, E., Bertelli, L., Bartolacelli, Y., Origliani, G., & Modena, M. G. (2013). Parity as predictor of early hypertension during menopausal transition. Journal of Hypertension, 31(3), 501–507. https://doi.org/10.1097/HJH.0b013e32835c1742. (Discussion 507).

    Article  CAS  PubMed  Google Scholar 

  9. Gold, R. A., Gold, K. R., Schilling, M. F., & Modilevsky, T. (2014). Effect of age, parity, and race on the incidence of pregnancy associated hypertension and eclampsia in the United States. Pregnancy Hypertens, 4(1), 46–53. https://doi.org/10.1016/j.preghy.2013.10.001.

    Article  PubMed  Google Scholar 

  10. Goldman, G. A., Kaplan, B., Neri, A., Hecht-Resnick, R., Harel, L., & Ovadia, J. (1995). The grand multipara. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 61(2), 105–109.

    Article  CAS  PubMed  Google Scholar 

  11. Gunderson, E. P., Chiang, V., Lewis, C. E., Catov, J., Quesenberry, C. P., Sidney, S., et al. (2008). Long-term blood pressure changes measured from before to after pregnancy relative to nonparous women. Obstetrics and Gynecology, 112(6), 1294–1302. https://doi.org/10.1097/AOG.0b013e31818da09b.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gunnlaugsson, S. R., Geirsson, R. T., Snaedal, G., & Hallgrimsson, J. T. (1989). Incidence and relation to parity of pregnancy-induced hypertension in Iceland. Acta Obstetricia et Gynecologica Scandinavica, 68(7), 599–601.

    Article  CAS  PubMed  Google Scholar 

  13. Jang, M., Lee, Y., Choi, J., Kim, B., Kang, J., Kim, Y., et al. (2015). Association between parity and blood pressure in Korean women: Korean national health and nutrition examination survey, 2010–2012. Korean Journal of Family Medicine, 36(6), 341–348. https://doi.org/10.4082/kjfm.2015.36.6.341.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jim, B., Sharma, S., Kebede, T., & Acharya, A. (2010). Hypertension in pregnancy: A comprehensive update. Cardiology in Review, 18(4), 178–189. https://doi.org/10.1097/CRD.0b013e3181c60ca6.

    Article  PubMed  Google Scholar 

  15. Khalid, M. E. (2006). The effect of age, obesity and parity on blood pressure and hypertension in non-pregnant married women. Journal of Family and Community Medicine, 13(3), 103–107.

    PubMed  Google Scholar 

  16. Kristiansson, P., & Wang, J. X. (2001). Reproductive hormones and blood pressure during pregnancy. Human Reproduction, 16(1), 13–17.

    Article  CAS  PubMed  Google Scholar 

  17. Lao, X. Q., Thomas, G. N., Jiang, C. Q., Zhang, W. S., Yin, P., Schooling, M., et al. (2006). Parity and the metabolic syndrome in older Chinese women: The Guangzhou Biobank Cohort Study. Clinical Endocrinology, 65(4), 460–469. https://doi.org/10.1111/j.1365-2265.2006.02615.x.

    Article  CAS  PubMed  Google Scholar 

  18. Lisonkova, S., & Joseph, K. S. (2013). Incidence of preeclampsia: Risk factors and outcomes associated with early- versus late-onset disease. American Journal of Obstetrics and Gynecology, 209(6), 544.e541–544.e512. https://doi.org/10.1016/j.ajog.2013.08.019.

    Article  Google Scholar 

  19. Lupton, S. J., Chiu, C. L., Lujic, S., Hennessy, A., & Lind, J. M. (2013). Association between parity and breastfeeding with maternal high blood pressure. American Journal of Obstetrics and Gynecology, 208(6), 454.e1–454.e7. https://doi.org/10.1016/j.ajog.2013.02.014.

    Article  Google Scholar 

  20. Macdonald-Wallis, C., Tilling, K., Fraser, A., Nelson, S. M., & Lawlor, D. A. (2013). Gestational weight gain as a risk factor for hypertensive disorders of pregnancy. American Journal of Obstetrics and Gynecology, 209(4), 327.e1–327.e17. https://doi.org/10.1016/j.ajog.2013.05.042.

    Article  Google Scholar 

  21. MacDorman, M. F., & Atkinson, J. O. (1998). Infant mortality statistics from the linked birth/infant death data set–1995 period data. Monthly Vital Statistics Report, 46(6 Suppl 2), 1–22.

    CAS  PubMed  Google Scholar 

  22. MacDorman, M. F., & Gregory, E. C. (2015). Fetal and Perinatal Mortality: United States, 2013. National Vital Statistics Reports, 64(8), 1–24.

    PubMed  Google Scholar 

  23. Mammaro, A., Carrara, S., Cavaliere, A., Ermito, S., Dinatale, A., Pappalardo, E. M., et al. (2009). Hypertensive disorders of pregnancy. Journal of Prenatal Medicine, 3(1), 1–5.

    PubMed  PubMed Central  Google Scholar 

  24. Moon, M., & Odibo, A. (2015). First-trimester screening for preeclampsia: impact of maternal parity on modeling and screening effectiveness. Journal of Maternal-Fetal and Neonatal Medicine, 28(17), 2028–2033. https://doi.org/10.3109/14767058.2014.978758.

    Article  PubMed  Google Scholar 

  25. Nakagawa, K., Lim, E., Harvey, S., Miyamura, J., & Juarez, D. T. (2016). Racial/ethnic disparities in the association between preeclampsia risk factors and preeclampsia among women residing in Hawaii. Maternal and Child Health Journal, 20(9), 1814–1824. https://doi.org/10.1007/s10995-016-1984-2.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Odegård, R. A., Vatten, L. J., Nilsen, S. T., Salvesen, K. A., & Austgulen, R. (2000). Risk factors and clinical manifestations of pre-eclampsia. BJOG, 107(11), 1410–1416.

    Article  PubMed  Google Scholar 

  27. Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A. B., Daniels, J., et al. (2014). Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health, 2(6), e323–e333. https://doi.org/10.1016/S2214-109X(14)70227-X.

    Article  PubMed  Google Scholar 

  28. Siddiqui, M., Minhaj, M., Mueller, A., Tung, A., Scavone, B., Rana, S., et al. (2017). Increased perinatal morbidity and mortality among Asian American and Pacific Islander women in the United States. Anesthesia and Analgesia, 124, 879–886. https://doi.org/10.1213/ANE.0000000000001778.

    Article  PubMed  Google Scholar 

  29. Steegers, E. A., von Dadelszen, P., Duvekot, J. J., & Pijnenborg, R. (2010). Pre-eclampsia. Lancet, 376(9741), 631–644. https://doi.org/10.1016/S0140-6736(10)60279-6.

    Article  Google Scholar 

  30. Strevens, H., Wide-Swensson, D., & Ingemarsson, I. (2001). Blood pressure during pregnancy in a Swedish population; impact of parity. Acta Obstetricia et Gynecologica Scandinavica, 80(9), 824–829.

    Article  CAS  PubMed  Google Scholar 

  31. Taylor, J. Y., Chambers, A. N., Funnell, B., & Wu, C. Y. (2008). Effects of parity on blood pressure among African-American women. The Journal of National Black Nurses Association, 19(2), 12–19.

    Google Scholar 

  32. Toohey, J. S., Keegan, K. A., Morgan, M. A., Francis, J., Task, S., & deVeciana, M. (1995). The “dangerous multipara”: Fact or fiction? American Journal of Obstetrics and Gynecology, 172(2 Pt 1), 683–686.

    Article  CAS  PubMed  Google Scholar 

  33. Zeeman, G. G. (2009). Neurologic complications of pre-eclampsia. Seminars in Perinatology, 33(3), 166–172. https://doi.org/10.1053/j.semperi.2009.02.003.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Chaohua Li.

Ethics declarations

Conflict of interest

The authors have declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, C., Binongo, J.N. & Kancherla, V. Effect of Parity on Pregnancy-Associated Hypertension Among Asian American Women in the United States. Matern Child Health J 23, 1098–1107 (2019). https://doi.org/10.1007/s10995-019-02746-z

Download citation

Keywords

  • Parity
  • Pregnancy-associated hypertension
  • Asian American
  • Risk factors
  • Maternal health