Amy A Goodwin1, Brian M Mercer. 1. Department of Obstetrics and Gynecology, MetroHealth Medical Center at Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Abstract
OBJECTIVE: There is considerable variation in the expression of severe preeclampsia. Our purpose was to determine if this is associated with maternal race or ethnicity. STUDY DESIGN: Individual chart review was performed for women diagnosed with severe preeclampsia at a tertiary care center from 1993 to 2003. Demographic, clinical, and lab findings from diagnosis (Dx) to 6 weeks' postpartum (PP) were documented. Data were compared between Caucasian, African American, and Hispanic women. Data were presented for the total cohort if no significant difference was found. RESULTS: We evaluated 473 pregnancies: 201 (Caucasian), 216 (African American), and 56 (Hispanic). Groups had similar baseline characteristics: chronic hypertension (HTN), diabetes, and initial antenatal blood pressure (mean BP 118/68). Caucasian women were older (27 vs 24 yrs), more likely nulliparous (63 vs 49%), and had more multiple gestations (9 vs 1.5%), P < .002 for each. African Americans had less epigastric pain (7.4 vs 10%) and nausea (2.3 vs 5%), P < .05 for each. Platelets <100,000/microL and asparate aminotransferase >60 mg/dL were more common in Caucasian women at Dx (9 vs 12%, 11 vs 21%) and at delivery (14 vs 24%, 19 vs 34%), P < .05 for each. No difference in severe proteinuria was seen. African Americans had more severe HTN at both Dx (44.9 vs 30%) and peak BP (85 vs 67%), and required more antihypertensive Rx intrapartum (12 vs 6%), PP (38 vs 12%), and at discharge (35 vs. 21%), P < .03 for each. Hispanics presented later (36 vs 34.6 weeks) and had less severe HTN (27 vs 40%), P < .04 for each. BP on DC was not different between groups. Caucasian women had more hemolysis, elevated liver enzymes and low platelets syndrome (29 vs 19%, P = .01). Eclampsia, intrauterine fetal demise, intrauterine growth restriction, abruption, PP preeclampsia, and recurrent preeclampsia were similar between groups. CONCLUSION: African American women with severe preeclampsia demonstrate more severe hypertension and required more antihypertensive Rx, while Caucasian women have more frequent hemolysis, elevated liver enzymes and low platelets syndrome.
OBJECTIVE: There is considerable variation in the expression of severe preeclampsia. Our purpose was to determine if this is associated with maternal race or ethnicity. STUDY DESIGN: Individual chart review was performed for women diagnosed with severe preeclampsia at a tertiary care center from 1993 to 2003. Demographic, clinical, and lab findings from diagnosis (Dx) to 6 weeks' postpartum (PP) were documented. Data were compared between Caucasian, African American, and Hispanic women. Data were presented for the total cohort if no significant difference was found. RESULTS: We evaluated 473 pregnancies: 201 (Caucasian), 216 (African American), and 56 (Hispanic). Groups had similar baseline characteristics: chronic hypertension (HTN), diabetes, and initial antenatal blood pressure (mean BP 118/68). Caucasian women were older (27 vs 24 yrs), more likely nulliparous (63 vs 49%), and had more multiple gestations (9 vs 1.5%), P < .002 for each. African Americans had less epigastric pain (7.4 vs 10%) and nausea (2.3 vs 5%), P < .05 for each. Platelets <100,000/microL and asparate aminotransferase >60 mg/dL were more common in Caucasian women at Dx (9 vs 12%, 11 vs 21%) and at delivery (14 vs 24%, 19 vs 34%), P < .05 for each. No difference in severe proteinuria was seen. African Americans had more severe HTN at both Dx (44.9 vs 30%) and peak BP (85 vs 67%), and required more antihypertensive Rx intrapartum (12 vs 6%), PP (38 vs 12%), and at discharge (35 vs. 21%), P < .03 for each. Hispanics presented later (36 vs 34.6 weeks) and had less severe HTN (27 vs 40%), P < .04 for each. BP on DC was not different between groups. Caucasian women had more hemolysis, elevated liver enzymes and low platelets syndrome (29 vs 19%, P = .01). Eclampsia, intrauterine fetal demise, intrauterine growth restriction, abruption, PP preeclampsia, and recurrent preeclampsia were similar between groups. CONCLUSION: African American women with severe preeclampsia demonstrate more severe hypertension and required more antihypertensive Rx, while Caucasian women have more frequent hemolysis, elevated liver enzymes and low platelets syndrome.
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