New research published in the Journal of the American Heart Association reveals significant disparities in pregnancy-related high blood pressure risk among Asian American, Native Hawaiian and Pacific Islander subgroups, with Pacific Islander and Filipino individuals facing substantially higher risks than their Chinese counterparts. The findings underscore the importance of moving beyond broad racial categories to develop targeted prevention and treatment strategies for diverse populations.
The study analyzed California health records from 2007-2019 for 772,688 pregnant individuals who self-identified as Asian American, Native Hawaiian or Pacific Islander. Researchers examined five hypertensive disorders of pregnancy: chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with preeclampsia. Pregnancy-related high blood pressure increases the risk of heart attack and stroke and is one of the leading causes of maternal illness and death, according to the U.S. Centers for Disease Control and Prevention.
The analysis found the lowest frequency of pregnancy-related high blood pressure in the Chinese subgroup at 3.7%, while the Guamanian subgroup had the highest frequency at 13%. Using the Chinese population as the reference point, the risk of pregnancy-related high blood pressure conditions was elevated two to three times higher among Filipino and Pacific Islander populations, including Hawaiian, Guamanian, Samoan and other Pacific Islander individuals, after adjusting for sociodemographic and maternal-health factors. Only Japanese, Korean and Vietnamese individuals tended to have risks that were not elevated compared to the Chinese reference group.
"There are known ways to help prevent and treat high blood pressure during pregnancy. Our findings can help health care professionals identify those who are at higher risk," said study lead author Jennifer Soh, M.S., who conducted the research while at Stanford University School of Medicine. "Early identification and treatment can help prevent serious, downstream complications for both the pregnant individuals and their infants." The American Heart Association notes that these conditions can be managed and treated with medication or lifestyle changes. Previous research has indicated that the risk of developing pregnancy-related high blood pressure differs among people of different races and ethnicities due to social determinants of health, but little was known about differences within Asian American, Native Hawaiian and Pacific Islander populations as they are often studied together despite their diversity.
"The observed racial-ethnic differences in risk highlight the variation in lived experiences of the individuals included in this study," Soh said. "Future studies should examine more structural and social factors that could help explain the differences in the elevated risks found in this study." The study had several limitations, including reliance on medical diagnostic codes that may be subject to underreporting, data limited to California residents, and inability to account for COVID-19 pandemic effects or factors like air pollution and neighborhood walkability.
The research emphasizes that healthcare approaches must recognize the substantial diversity within racial and ethnic categories. More information about pregnancy and maternal health is available through the American Heart Association at https://www.heart.org/en/health-topics/high-blood-pressure/pregnancy-and-high-blood-pressure. The full study manuscript will be available online after January 14, 2026.
