Lumping Asian American, Native Hawaiian and Pacific Islander pregnant people into one health category has been hiding a deadly problem.
When researchers from the Journal of the American Heart Association finally split up the data, they found pregnant individuals who identify as Filipino and Pacific Islander develop dangerous high blood pressure during pregnancy at three times the rate of Chinese women. That gap could lead to severe health consequences.
The broad “Asian American” label used in most medical research has been masking these disparities for years. The Journal of the American Heart Association’s latest study attempts to unmask them.
Researchers examined records from 772,000 Asian American and Pacific Islander pregnancies in California between 2007 and 2019. Instead of treating everyone as one group, they broke the data into 15 specific ethnic categories.
The differences were dramatic. Guamanian women had pregnancy related high blood pressure 13 percent of the time. Chinese women had it just 3.7 percent of the time. Hawaiian, Samoan and other Pacific Islander women showed similarly high rates. So did Filipino women.
Japanese, Korean and Vietnamese women had the lowest risk, similar to Chinese women.
Hypertensive disorders are a leading cause of pregnancy related deaths in the United States, according to the Centers for Disease Control and Prevention. The condition raises the risk of heart attacks and strokes both during and long after pregnancy.
“There are known ways to help prevent and treat high blood pressure during pregnancy,” said Jennifer Soh in the study published Wednesday, January 14, in the Journal of the American Heart Association. Soh led the research while getting her master’s at Stanford. “Our findings can help health care professionals identify those who are at higher risk.”
The problem is that most medical systems still track all these groups together. That means doctors might not know which pregnant patients need closer monitoring. It means public health officials might not direct resources to the communities that need them most.
About 1 in 7 pregnancies in the United States involve some form of high blood pressure, according to the American Heart Association. These conditions can be managed with medication and lifestyle changes when caught early.
The study looked at five types of pregnancy blood pressure problems, from basic high blood pressure to more dangerous complications. Preeclampsia damages organs and causes too much protein in urine. Eclampsia can cause seizures.
Even after researchers accounted for age, insurance status and other health factors, Filipino and Pacific Islander women still faced dramatically higher risks. That suggests something beyond genetics is at work.
“The observed racial ethnic differences in risk highlight the variation in lived experiences of the individuals included in this study,” Soh said in the American Heart Association announcement. “Future studies should examine more structural and social factors that could help explain the differences in the elevated risks found in this study.”
Those factors might include neighborhood conditions, food access or air quality. The current study could not examine them because the data was not collected that way.
Research from the CDC shows that during 2017 to 2019, about 31.6 percent of deaths that occurred during delivery hospitalization had a hypertensive disorder documented. The prevalence of these conditions increased from 13.3 percent to 15.9 percent during that period.
The study had limitations. It only included people in California, so results might differ elsewhere. The research ended before the COVID 19 pandemic. And it relied on medical billing codes, which doctors sometimes record incorrectly.
But the findings point to a bigger problem with how the medical system categorizes patients. Grouping diverse populations under labels like “Asian American” can hide health disparities that kill people.
“Early identification and treatment can help prevent serious, downstream complications for both the pregnant individuals and their infants,” Soh told the American Heart Association.
The American Heart Association recommends that pregnant individuals at a higher risk get more frequent blood pressure monitoring throughout pregnancy and after delivery. But doctors need to know who is actually at higher risk first.
The study divided participants into 15 groups: Chinese, Japanese, Korean, Vietnamese, Cambodian, Thai, Laotian, Hmong, Indian, Filipino, Other Asian, Hawaiian, Guamanian, Samoan and Other Pacific Islander. The average age was 32.
Researchers used birth certificates, death certificates and hospital discharge records from the California Department of Health Care Access and Information to track high blood pressure diagnoses during pregnancy.
Registration is closed for Common Ground: Building Together conference and gala award banquet in San Francisco on January 24. A shoutout to our planning committee: Jane Chin, Frank Mah, Jeannie Young, Akemi Tamanaha, Nathan Soohoo, Mark Young, Dave Liu, and Yiming Fu.
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Slug: pregnancy-heart-related-issue-Filipino-Chinese-Asian-american
