Maternal race and pre-eclampsia: Cohort study and systematic review with meta-analysis

Abstract

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

Design: Prospective observational study and systematic review with meta-analysis.

Setting: Two UK maternity hospitals.

Population: A total of 168 966 women with singleton pregnancies attending for routine ultrasound examination at 11-13 weeks of gestation without major abnormalities delivering at 24 weeks or more of gestation.

Methods: Regression analysis examined the association between race and pre-eclampsia or gestational hypertension in the FMF data. Literature search to December 2021 was carried out to identify peer-reviewed publications on race and pre-eclampsia.

Main outcome measure: Relative risk of pre-eclampsia and gestational hypertension in women of black, South Asian and East Asian race by comparison to white women.

Results: In black women, the respective risks of total-pre-eclampsia and preterm-pre-eclampsia were 2-fold and 2.5-fold higher, respectively, and risk of gestational hypertension was 25% higher; in South Asian women there was a 1.5-fold higher risk of preterm pre-eclampsia but not of total-pre-eclampsia 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 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 contributions on different racial groups to the prediction of pre-eclampsia.

Conclusion: In women of black and South Asian origin the risk of pre-eclampsia, after adjustment for confounders, is higher than in white women.

Keywords: first-trimester screening; gestational hypertension; meta-analysis; pre-eclampsia; race; systematic review.