Maternal race and preeclampsia: cohort study and systematic review with meta‐analysis

Objectives

To examine the association between race and preeclampsia(PE) and gestational hypertension(GH) after adjustment for factors in maternal characteristics and medical history in screening study from the Fetal Medicine Foundation (FMF) in England, and to perform a systematic review and meta-analysis of studies on PE.

Methods

In the FMF data regression analysis was performed to examine the association between race and PE or GH. literature search to December 2021 was carried out to identify peer-reviewed publications on race and PE.

Main outcome measure

Relative risk of PE and GH in women of black, South Asian and East Asian race by comparison to white women.

Results

In the FMF study there were 168,966 singleton pregnancies without major abnormalities delivering at ≥24 weeks’ gestation. In black women the respective risk of total-PE and preterm-PE was 2-fold and 2.5-fold higher and risk of GH was 25% higher, in South Asian women there was a 1.5-fold higher risk of preterm-PE but not total-PE, and in East Asian women there was no statistically significant difference in risk of hypertensive disorders. The literature search identified 19 studies that provided data on several million of pregnancies, but 17 were at moderate or high-risk of bias and only three provided risks adjusted for some maternal characteristics; consequently, these studies did not provide accurate contribution of different racial groups to the prediction of PE.

Conclusion

In women of black and South Asian origin the risk of PE, after adjustment for confounders, is higher than in white women.