Researchers analysed 1,880,400 births in California between 2007 and 2019, including live births and stillbirths from 20 weeks of pregnancy onward. The study examined maternal age, race and ethnicity, education and insurance status, along with cardiovascular and pregnancy-related health outcomes.
The findings showed clear differences in pregnancy-related blood pressure conditions. Hypertensive disorders of pregnancy occurred in 14.2% of births among Black women, compared with 9.2% among White women. Non-optimal cardiovascular health before pregnancy was also more common among Black women, affecting 60.9%, compared with 45.2% of White women.
Age Linked to Sharper Risk Increase
The researchers found that cardiometabolic risks increased more rapidly with age among Black women across socioeconomic groups.
Among college-educated Black women, every five-year increase in age was associated with a 27% higher risk of hypertensive disorders of pregnancy. Among White women with a high-school education or less, the increase was 23%.
The difference was particularly notable for chronic hypertension. For Black women with a high-school education or less, every five-year increase in age was associated with a 79% increase in risk. Among college-educated White women, the corresponding increase was 41%.
The researchers said higher socioeconomic status did not completely remove these differences. Black women with greater socioeconomic advantage could still experience similar or higher age-related risks than White women in more disadvantaged groups.
Need for Earlier Action
The findings are consistent with the concept of “weathering,” which suggests that repeated exposure to social and structural adversity may contribute to faster health deterioration over time.
However, the researchers stressed that the study was observational and cross-sectional, meaning it cannot prove that socioeconomic or structural factors directly caused the differences.
They said maternal cardiovascular health should be understood through the combined effects of age, race, socioeconomic conditions and long-term stress. The findings support earlier interventions aimed at addressing structural factors and chronic health risks before pregnancy.
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