Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women

Kharah M. Ross, Christine Dunkel Schetter, Monica R. McLemore, Brittany D. Chambers, Randi A. Paynter, Rebecca Baer, Sky K. Feuer, Elena Flowers, Deborah Karasek, Matthew Pantell, Aric A. Prather, Kelli Ryckman, Laura Jelliffe-Pawlowski

Research output: Contribution to journalJournal Articlepeer-review

62 Citations (Scopus)


Background: Higher socioeconomic status (SES) has less impact on cardio-metabolic disease and preterm birth risk among Black women compared to White women, an effect called “diminishing returns.” No studies have tested whether this also occurs for pregnancy cardio-metabolic disease, specifically preeclampsia, or whether preeclampsia risk could account for race-by-SES disparities in birth timing. Methods: A sample of 718,604 Black and White women was drawn from a population-based California cohort of singleton births. Education, public health insurance status, gestational length, and preeclampsia diagnosis were extracted from a State-maintained birth cohort database. Age, prenatal care, diabetes diagnosis, smoking during pregnancy, and pre-pregnancy body mass index were covariates. Results: In logistic regression models predicting preeclampsia risk, the race-by-SES interaction (for both education and insurance status) was significant. White women were at lower risk for preeclampsia, and higher SES further reduced risk. Black women were at higher risk for preeclampsia, and SES did not attenuate risk. In pathway analyses predicting gestational length, an indirect effect of the race-by-SES interaction was observed. Among White women, higher SES predicted lower preeclampsia risk, which in turn predicted longer gestation. The same was not observed for Black women. Conclusions: Compared to White women, Black women had increased preeclampsia risk. Higher SES attenuated risk for preeclampsia among White women, but not for Black women. Similarly, higher SES indirectly predicted longer gestational length via reduced preeclampsia risk among White women, but not for Black women. These findings are consistent with diminishing returns of higher SES for Black women with respect to preeclampsia.

Original languageEnglish
Pages (from-to)1182-1191
Number of pages10
JournalJournal of Racial and Ethnic Health Disparities
Issue number6
Publication statusPublished - 1 Dec. 2019


  • Gestational length
  • Health disparities
  • Preeclampsia
  • Race/ethnicity
  • Socioeconomic status


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