The association between ethnicity and pre-eclampsia in Australia: A multicentre retrospective cohort study.

ABSTRACT

BACKGROUND: Rates of pre-eclampsia vary between countries and certain ethnic groups. However, there is limited evidence about the impact of ethnicity on risk of pre-eclampsia, beyond established clinical risk factors. AIMS: To assess the association between ethnicity and pre-eclampsia in Australia's diverse multi-ethnic population. MATERIALS AND METHODS: We conducted a retrospective cohort study using the ObstetriX database. We included all women with a birth between January 2011 and December 2014, at Auburn, Blacktown/Mount-Druitt and Westmead Hospitals in the Western Sydney Local Health District. We estimated the pre-eclampsia rate overall, and by maternal ethnic group, defined by country of birth and primary language. We developed multivariable logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CIs) for pre-eclampsia, adjusting for maternal age, body mass index, autoimmune disease, chronic hypertension, chronic renal disease, diabetes mellitus (type 1 or 2), and multiple pregnancy. A secondary analysis was restricted to nulliparous women. RESULTS: There were 40 824 women evaluated, including 12 743 nulliparous women. Of these, 1448 (3.5%) developed pre-eclampsia (range Australian/New Zealand-born English speakers 735/15 422 (4.8%); North-East Asian women 51/4470 (1.1%)). Relative to Australian/New Zealand-born English speakers, immigrants had a lower risk of pre-eclampsia overall (adjusted OR 0.67; 95% CI 0.60-0.75); as did the three largest immigrant groups examined Southern Asian (0.73; 0.62-0.85), Middle-Eastern/African (0.55; 0.47-0.66) and North-East Asian (0.33; 0.25-0.45) women. Findings were similar for nulliparous women. CONCLUSIONS: Certain immigrant groups are at lower risk of pre-eclampsia than Australian/New Zealand-born English-speaking women. Understanding why this is so may lead to better screening and preventive strategies in higher-risk women.