Ethnocultural status and risk of preeclampsia in a Canadian setting

Abstract

Objectives

Disparities in hypertensive disorders of pregnancy are prevalent in the U.S., but are understudied in other settings. Our objective was to determine if ethnocultural disparity in the risk of preeclampsia was present in Canada.

Study design

We carried out a retrospective cohort study of 862,759 pregnancies between 2008 and 2020 in Quebec, Canada. The exposure was the ethnocultural status of women, defined by linguistic origin (Anglophone or Francophone).

Main outcome measures

The outcome was preeclampsia, including severity (severe, superimposed, mild), presence of fetal growth restriction, and gestational onset time (early or late onset of hypertension). We estimated risk ratios (RR) and 95 % confidence intervals (CI) for the association between ethnocultural status and risk of preeclampsia adjusted for maternal characteristics.

Results

In adjusted models, Anglophones had a slightly elevated risk of preeclampsia compared with Francophones (40.5 vs. 37.2 per 1000 pregnancies; RR 1.03, 95 % CI 1.00–1.07). Associations were stronger for selected subtypes of preeclampsia, with Anglophones at greater risk of mild preeclampsia (RR 1.09, 95 % CI 1.04–1.13), preeclampsia without fetal growth restriction (RR 1.04, 95 % CI 1.00–1.08), and late onset preeclampsia (RR 1.04, 95 % CI 1.01–1.08). An association with severe preeclampsia was less apparent, although Anglophones lacking a high school diploma (RR 1.46, 95 % CI 1.12–1.90) or who were younger than 25 years (RR 1.19, 95 % CI 1.01–1.40) had a greater risk of severe preeclampsia compared with Francophones.

Conclusions

Anglophones, especially Anglophones in vulnerable subgroups, have a slightly elevated risk of preeclampsia compared with Francophones.

Abbreviations: CI, confidence interval; HELLP, hemolysis, elevated liver enzymes, and low platelets; ICD-10-CA, International Classification of Diseases, 10th revision; mmHg, millimeter of mercury; No., number; RR, risk ratio; U.S., United States.