Recurrent pregnancy loss may raise risk for hypertensive disorders among Black women

Key takeaways:

• Black women with a history of recurrent pregnancy loss were more likely to develop hypertensive disorders of pregnancy.
• History of recurrent pregnancy loss was also tied to earlier delivery and lower birth weights.

DENVER — Black women with a history of recurrent pregnancy loss had a higher likelihood of developing hypertensive disorders of pregnancy, delivering offspring earlier and delivering offspring with lower birth weights, researchers reported.

“Previous studies have demonstrated a relationship between hypertensive disorders of pregnancy and recurrent pregnancy loss, though these have been explored in racial homogenous populations and have not included large numbers of Black women or controlled for race or socioeconomic status,” Micaela Stevenson Wyszewianski, MD, a third-year resident in the department of obstetrics and gynecology at the Medical College of Wisconsin, said during a presentation at the ASRM Scientific Congress & Expo.

Stevenson Wyszewianski and colleagues performed a retrospective cohort study that included Black women with (n = 252) and without (n = 2,346) a history of recurrent pregnancy loss, which was defined as two or more pregnancy losses at any gestational age from 2017 to 2022 at a single academic center. The women included in the study delivered at more than 20 weeks’ gestation and had an income of 135% or lower of the federal poverty level.

Researchers evaluated pregnancy outcomes including development of hypertensive disorders of pregnancy, preterm delivery, infant birth weight and Apgar scores and obtained data on age, BMI, gravidity and parity, history of chronic hypertension, aspirin and heparin use, prior hypertensive disorders of pregnancy and smoking status.

Women with a history of recurrent pregnancy loss were older (mean age, 29.9 years vs. 25.9 years), had higher gravidity (2.79 vs. 1.88), were more likely to be current smokers (29% vs. 16%) and had a higher likelihood of chronic hypertension (22% vs. 10%) compared with women without this history (P < .001 for all).

Women with a history of recurrent pregnancy loss were also more likely to develop hypertensive disorders of pregnancy during a subsequent pregnancy (10.27% vs. 23.41%; P < .05). When the researchers looked at specific hypertensive disorders of pregnancy, women with vs. without a history of recurrent pregnancy loss had higher risk for gestational hypertension (11% vs. 7.8%), preeclampsia without severe features (2.8% vs. 2.3%) and preeclampsia with severe features (9.5% vs. 4.5%).

In addition, women with a history of recurrent pregnancy loss delivered nearly 1 week earlier vs. women without this history (36.8 weeks’ vs. 37.89 weeks’ gestation; P < .05). Birth weight was also lower for offspring born to women with vs. without recurrent pregnancy loss (2,794 g vs. 2,970 g; P = .001).

“Future studies should be large, multi-institutional studies to assess additional outcomes,” Stevenson Wyszewianski said. “We’d also like to look at the relationship between aspirin and heparin use and the impact on developing hypertensive disorders of pregnancy, as well as assessing long-term health outcomes for patients with recurrent pregnancy loss and chronic hypertension.”