Interactions between race/ethnicity, poverty status, and pregnancy cardio-metabolic diseases in prediction of postpartum cardio-metabolic health

ABSTRACT

Background: Prenatal health disparities exist for African Americans and low socioeconomic status (SES) individuals when compared to non-Hispanic Whites and people of higher SES, particularly in cardio-metabolic diseases. Furthermore, having had a pregnancy-specific cardio-metabolic disease, e.g. preeclampsia, increases risk for future cardio-metabolic disease. Although these factors (race, SES and pregnancy cardio-metabolic disease) are interrelated, studies have rarely considered their combined effect on postpartum cardio-metabolic risk. The purpose of this study was to assess whether SES, race/ethnicity, and prenatal cardio-metabolic disease interact in the prediction of postpartum cardio-metabolic risk.

Methods: A sample of 1,753 low-income women of African American, Latina, non-Hispanic White race/ethnicity was recruited after a birth in 5 US sites. Household income was used to categorize poverty status as Poor (< Federal Poverty Level; FPL), near poor (100–200% FPL), or low/middle income (> 200% FPL). Three prenatal cardio-metabolic disease diagnoses (preeclampsia, gestational hypertension, gestational diabetes) were identified from medical records. Four biomarkers (mean arterial pressure, glycosylated haemoglobin, total cholesterol:HDL ratio, and waist-hip ratio) were collected at 6 and 12 months postpartum, and combined into an average postpartum cardio-metabolic risk index. Maternal age, pre-pregnancy body mass index, parity, health behaviors and employment status were covariates.

Results: Analyses revealed interactions of race/ethnicity, poverty status, and prenatal cardio-metabolic diseases in the prediction of postpartum cardio-metabolic risk. African American women had higher postpartum cardio-metabolic risk, which was exacerbated following a prenatal cardio-metabolic disease. Low/middle income African American women had higher cardio-metabolic risk compared to poor African American, and all Latina and White women.

Conclusions: African American women, and especially those who experienced pregnancy complications, emerged as vulnerable, and greater household income did not appear to confer protection against worse postpartum cardio-metabolic risk for this group. These results highlight the complex interplay between socioeconomic status and race/ethnicity with respect to understanding health disparities.

KEYWORDS:

• Pregnancy
• postpartum
• race/ethnicity
• poverty
• cardio-metabolic risk
• gestational hypertension
• gestational diabetes
• pre-eclampsia
• widening health disparities

Disclosure statement

No potential conflict of interest was reported by the authors.

Key messages

• In a sample of poor to low/middle income women, African American women were at significantly greater risk for having a prenatal cardio-metabolic disease (gestational hypertension, gestational diabetes, pre-eclampsia) relative to non-Latina White and Latina women

• A ‘reverse’ socioeconomic gradient was observed in this sample of low-income African American women, such that poor African American women had lower postpartum cardio-metabolic risk compared to African American women with higher incomes and compared to all Latina and White women.

Notes

1 Total cholesterol:HDL ratio was the least stable (r = .21), likely due to these samples being non-fasting.

Additional information

Funding

This work was supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development [grant number R03 HD59584,U HD44207,U HD44219,U HD44226,U HD44226-05S1,U HD44245,U HD44245-06S1,U HD44253,U HD54019,U HD54791]; National Institute for Nursing Research [grant number U NR008929].