Relationship of Preeclampsia With Maternal Place of Birth and Duration of Residence Among Non-Hispanic Black Women in the United States

Abstract

Background: Preeclampsia is one of the leading causes of maternal mortality in the United States. It disproportionately affects non-Hispanic Black (NHB) women, but little is known about how preeclampsia and other cardiovascular disease risk factors vary among different subpopulations of NHB women in the United States. We investigated the prevalence of preeclampsia by nativity (US born versus foreign born) and duration of US residence among NHB women. Methods: We analyzed cross-sectional data from the Boston Birth Cohort (1998–2016), with a focus on NHB women. We performed multivariable logistic regression to investigate associations between preeclampsia, nativity, and duration of US residence after controlling for potential confounders. Results: Of 2697 NHB women, 40.5% were foreign born. Relative to them, US-born NHB women were younger, in higher percentage current smokers, had higher prevalence of obesity (body mass index ≥30 kg/m 2 ) and maternal stress, but lower educational level. The age-adjusted prevalence of preeclampsia was 12.4% and 9.1% among US-born and foreign-born women, respectively. When further categorized by duration of US residence, the prevalence of all studied cardiovascular disease risk factors except for diabetes was lower among foreign-born NHB women with <10 versus ≥10 years of US residence. Additionally, the odds of preeclampsia in foreign-born NHB women with duration of US residence <10 years was 37% lower than in US-born NHB women. In contrast, the odds of preeclampsia in foreign-born NHB women with duration of US residence ≥10 years was not significantly different from that of US-born NHB women after adjusting for potential confounders. Conclusions: The prevalence of preeclampsia and other cardiovascular disease risk factors is lower in foreign-born than in US-born NHB women. The healthy immigrant effect, which typically results in health advantages for foreign-born women, appears to wane with longer duration of US residence (≥10 years). Further research is needed to better understand these associations.

Birth outcomes across the spectrum of maternal age: dissecting aging effect versus confounding by social and medical determinants

“…The study also observed that US nativity worsened the risk of adverse outcomes while nulliparity was protective. Our findings and other recent publication from the BBC [ 28 , 29 ] corroborate the healthy migrant theory [ 30 ] which has been documented among South America and Asia born US migrants [ 31 ]. However, given this study does not disaggregate women by race and nativity, the degree to which this would apply to Black migrants specifically and warrants further investigation.…”

Nativity-Related Disparities in Preeclampsia and Cardiovascular Disease Risk Among a Racially Diverse Cohort of US Women

“…47 This protective advantage of individuals born outside the US has been demonstrated among non-Hispanic Black women with shorter but not longer duration of US residence. 9 With longer duration of US residence, non-Hispanic Black women born outside the US adopt US behaviors such as smoking, which worsen their cardiovascular risk profile and health outcomes, thus losing the protective advantage of their nativity. 48 As has been described among non-Hispanic Black women, US-born Hispanic and non-Hispanic White women had higher prevalence of obesity, smoking, and complaints of severe stress compared with Hispanic and non-Hispanic White women born outside the US, respectively.…”

“…6,7 Although some studies have found Hispanic ethnicity to be independently associated with increased risk of preeclampsia, 6 others have found Hispanic women to have a less or similar risk of preeclampsia compared with non-Hispanic White women despite poorer socioeconomic profiles. 7,8 Previous studies 9,10 demonstrated the association of maternal nativity and duration of US residence with preeclampsia among non-Hispanic Black women. Non-Hispanic Black women who are born outside the US tend to have a lower prevalence of preeclampsia and other cardiovascular risk factors than their US-born counterparts.…”

“…Previous studies 9 , 10 demonstrated the association of maternal nativity and duration of US residence with preeclampsia among non-Hispanic Black women. Non-Hispanic Black women who are born outside the US tend to have a lower prevalence of preeclampsia and other cardiovascular risk factors than their US-born counterparts.…”

“…Non-Hispanic Black women who are born outside the US tend to have a lower prevalence of preeclampsia and other cardiovascular risk factors than their US-born counterparts. 9 , 11 Although these associations are well documented among non-Hispanic Black women, it is unclear whether maternal nativity and duration of US residence are independently associated with preeclampsia among women of other racial and ethnic groups. We build on these prior studies to examine the differences in cardiovascular risk factors, sociodemographic measures, and the cross-sectional association of preeclampsia with maternal nativity and duration of US residence among Hispanic, non-Hispanic Black, and non-Hispanic White women.…”