Volume 33, September 2023, Pages 8-16Author links open overlay panel, , , , , , , , , Highlights•

Emergency room utilization was greater in Black patients with preeclampsia than White.

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Preeclampsia blood testing was less frequent in the Black than White cohort.

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Antenatal steroids use for preterm labor was less frequent in the Black than White cohort.

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Severe maternal morbidity rates were higher in Black patients with preeclampsia vs White.

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Black patients had more cardiovascular disease and corresponding resource use/tests.

AbstractObjectives

To analyze healthcare resource utilization and severe maternal morbidity (SMM) in Black and White patients with preeclampsia diagnosis versus signs/symptoms.

Study design

This was a retrospective cohort study analyzing data from the IBM® Explorys Database between 7/31/2012–12/31/2020. Demographic, clinical, and laboratory data were extracted. Healthcare utilization and SMM were analyzed during the antepartum period (20 weeks of gestation until delivery) among Black and White patients with signs/symptoms of preeclampsia, with a diagnosis of preeclampsia, or neither (control).

Main outcome measures

Healthcare utilization and SMM in those with a preeclampsia diagnosis or signs/symptoms of preeclampsia only were compared with a control group (White patients with no preeclampsia diagnosis or signs/symptoms).

Results

Data from 38,190 Black and 248,568 White patients were analyzed. Patients with preeclampsia diagnosis or signs/symptoms were more likely to visit the emergency room compared to those without diagnosis or signs/symptoms. Black patients with signs/symptoms of preeclampsia had the highest elevated risk (odds ratio [OR] = 3.4), followed by Black patients with a preeclampsia diagnosis (OR = 3.2), White patients with signs/symptoms (OR = 2.2), and White patients with a preeclampsia diagnosis (OR = 1.8). More Black patients experienced SMM (SMM rate 6.1% [Black with preeclampsia diagnosis] and 2.6% [Black with signs/symptoms]) than White patients (5.0% [White with preeclampsia diagnosis] and 2.0% [White with signs/symptoms]). SMM rates were higher for Black preeclampsia patients with severe features than for White preeclampsia patients with severe features (8.9% vs 7.3%).

Conclusions

Compared with White patients, Black patients had higher rates of antepartum emergency care and antepartum SMM.

AbbreviationsCDC

Centers for Disease Control

EHR

electronic health records

HELLP

hemolysis-elevated liver enzymes-low platelet count

SMM

severe maternal morbidity

SNOMED

Systematized Nomenclature of Medicine

Keywords

Preeclampsia

Healthcare utilization

United States

Race

Disparity

Maternal morbidity

© 2023 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy.