Conti-Ramsden Frances, de Marvao Antonio, Chappell Lucy C
Reproduction. 2025 May 29;169(6). doi: 10.1530/REP-25-0049. Print 2025 Jun 1.
Ethnic disparities in hypertensive disorders of pregnancy (HDP) are well-described but poorly understood, with complex interplays between biological, environmental, socio-cultural and healthcare factors potentially contributing. This article provides a contemporary review of this topic and makes recommendations for research and clinical care to improve outcomes for minoritised women.
HDP affect approximately one in ten pregnancies and are associated with increased risk of adverse maternal and perinatal outcomes. Despite advances in prevention of pre-eclampsia and improved management of blood pressure in pregnancy, stark disparities in HDP incidence and outcomes persist across maternal ethnic groups. This article provides a contemporaneous review of the epidemiology of ethnic disparities in HDP, potential contributors to ethnic disparities, and how maternal ethnicity is currently conceptualised and utilised as a risk factor in clinical practice. We present the challenges of utilising ethnicity as a risk factor and suggest actions needed to tackle ethnic disparities in pregnancy hypertension. Women of Black ethnic backgrounds consistently experience a higher risk of pre-eclampsia, HDP and associated adverse outcomes compared to women of other ethnicities across diverse healthcare settings. While traditional cardiovascular risk factors and socioeconomic status contribute to these disparities, they do not fully explain the observed differences. Understanding these disparities requires research examining complex interactions across biological, behavioural, environmental, socio-cultural, and healthcare system factors. Ensuring appropriate diversity in HDP research is crucial for equitable application of incoming genomic and personalised medicine advances. While the fundamental drivers of ethnic disparities in HDP remain to be fully understood, healthcare systems should prioritise optimising blood pressure control during pregnancy and postpartum for women from minoritised ethnic backgrounds. Ensuring minoritised women with lived experience are equal partners in designing and implementing research and initiatives to address these disparities will be critical to their success.
妊娠高血压疾病（HDP）中的种族差异已有详尽描述，但人们对此了解不足，生物学、环境、社会文化和医疗保健因素之间的复杂相互作用可能起到了一定作用。本文对该主题进行了当代综述，并为研究和临床护理提出建议，以改善少数族裔妇女的结局。
HDP影响约十分之一的妊娠，并与孕产妇和围产期不良结局风险增加相关。尽管在预防子痫前期和改善孕期血压管理方面取得了进展，但HDP发病率和结局在不同孕产妇种族群体中仍存在明显差异。本文对HDP种族差异的流行病学、种族差异的潜在因素以及目前在临床实践中如何将孕产妇种族概念化并用作风险因素进行了当代综述。我们提出了将种族用作风险因素的挑战，并建议采取行动应对妊娠高血压方面的种族差异。在各种医疗环境中，与其他种族的女性相比，黑人种族背景的女性患子痫前期、HDP及相关不良结局的风险始终更高。虽然传统的心血管危险因素和社会经济地位导致了这些差异，但它们并不能完全解释所观察到的差异。理解这些差异需要研究生物性、行为、环境、社会文化和医疗系统因素之间的复杂相互作用。确保HDP研究具有适当的多样性对于公平应用即将到来的基因组学和个性化医学进展至关重要。虽然HDP种族差异的根本驱动因素仍有待充分了解，但医疗系统应优先为少数族裔背景的女性优化孕期和产后的血压控制。确保有实际经验的少数族裔女性在设计和实施解决这些差异的研究及举措中成为平等伙伴，将对其成功至关重要。
