Hypertensive Disorders of Pregnancy in Asian American, Native Hawaiian, and Pacific Islander Individuals in California, 2007 to 2019

BACKGROUND: Individuals who experience hypertensive disorders of pregnancy (HDPs) are at increased risk for downstream pregnancy-related complications, yet the variability in this risk among Asian American, Native Hawaiian, and Pacific Islander individuals remains understudied. This study investigated the risk for 5 HDP outcomes-chronic hypertension, chronic hypertension with superimposed preeclampsia, gestational hypertension, preeclampsia, and severe preeclampsia or eclampsia-among 15 disaggregated Asian American, Native Hawaiian, and Pacific Islander subgroups and assessed maternal characteristics that may be driving differences. METHODS: We used infant and fetal vital records linked to maternal hospital discharge records from births to Asian American, Native Hawaiian, and Pacific Islander individuals in California from 2007 to 2019. Modified Poisson regression models estimated risk ratios (RR) for each outcome with sequential adjustments to assess the contributions of maternal sociodemographic and health-related characteristics to variability in risk. The largest subgroup-Chinese individuals-was the reference group. RESULTS: The cohort included 772 688 individuals. Prevalence of HDPs ranged from 3.7% among Chinese individuals (n=7930) to 13.0% among Guamanian individuals (n=247). All Pacific Islander subgroups and Filipino individuals were consistently at higher risk for HDPs than Chinese individuals, whereas Korean, Vietnamese, and Japanese individuals tended to be at lowest risk. After full adjustment, the highest risk groups had adjusted relative risks 2- to 3-fold higher than Chinese individuals. CONCLUSIONS: The variability in HDP risk observed across Asian American, Native Hawaiian, and Pacific Islander populations further demonstrates the need to study health outcomes in disaggregated subgroups. These findings may help providers identify individuals at high risk for HDPs, enabling prevention, prompt treatment, and reduced adverse maternal health outcomes.