Trends and Racial and Ethnic Disparities in Maternal Cardiovascular Health in California

Background To address the maternal health crisis in the United States, it is important to closely examine the epidemiologic trends of and racial and ethnic disparities in maternal cardiovascular health. Methods We used statewide birth hospitalization and vital statistics records from California (2007–2019; N=6 117 886) to examine the prevalence, trends, and racial and ethnic disparities of hypertensive disorders of pregnancy overall (ie, chronic hypertension, gestational hypertension/preeclampsia, or eclampsia), and chronic hypertension and gestational hypertension/preeclampsia separately. We also examined a construct indicating ideal cardiovascular health before and during pregnancy using the subset of data with information available on clinical cardiovascular health indicators (ie, hypertension, diabetes, smoking, body mass index [kg/m 2 ], and gestational weight gain adjusted for gestational age; N=5 636 185). To quantify racial and ethnic disparities, we used modified Poisson regression models (with robust standard errors), controlling for sociodemographic characteristics, pregnancy‐related factors, and year fixed effects. Results The age‐standardized prevalence of adverse outcomes worsened over time for all racial and ethnic groups. Compared with non‐Hispanic White (White) individuals, non‐Hispanic Black mothers had higher risk of hypertensive disorders of pregnancy (risk ratio [RR], 1.60 [95% CI, 1.59–1.62]), including chronic hypertension (RR, 2.34 [95% CI, 2.29–2.38]) and gestational hypertension/preeclampsia (RR, 1.50 [95% CI, 1.49–1.52]). American Indian/Alaska Native mothers were less likely to have ideal cardiovascular health both before (RR, 0.66 [95% CI, 0.65–0.67]) and during pregnancy (RR, 0.80 [95% CI, 0.78–0.81]) compared with White mothers. These differences persisted throughout the study period. Conclusions Our findings reveal stark racial and ethnic disparities in maternal cardiovascular health, highlighting the urgent need to investigate and address their structural determinants.