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Poster Session 3

Category: Health Equity/Community Health

Poster Session 3

(988) Racial and ethnic differences in severe maternal morbidity associated with HELLP syndrome

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Yadira L. Bribiesca Leon, MD, MPH (she/her/hers)

Resident
Keck School of Medicine of USC, University of Southern California
Los Angeles, California, United States

Coauthor(s)

Ariane C. Youssefzadeh, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
ZC

Zaira Chavez Jimenez, MD

Keck School of Medicine of USC, University of Southern California
Los Angeles, California, United States
Fay Pon, MD (she/her/hers)

Resident Physician
Keck School of Medicine of USC, University of Southern California
Los Angeles, California, United States
ES

Elizabeth B. Sasso, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
Gordon J. Brian, MD, MSPH

MFM Fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
BG

Brendan H. Grubbs, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
NC

Nicole M. Chadwick, MD

Department of Obstetrics and Gynecology, Los Angeles General Medical Center
Los Angeles, California, United States
MI

Marc H. Incerpi, MD

Clinical Professor of Obstetrics and Gynecology
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
JO

Joseph G. Ouzounian, MBA, MD

Professor and Chair of Obstetrics & Gynecology
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
KM

Koji Matsuo, MD, PhD

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States

Objective:
To assess race/ethnicity-specific differences in severe maternal morbidity (SMM) associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

Study Design:
This cross-sectional study included 62,715 hospital deliveries with a diagnosis of HELLP syndrome from 2016-2022, obtained from the National Inpatient Sample. Exposure was race/ethnicity, including White (n=36,060), Hispanic (n=14,075), Black (n=10,020), or Asian (n=2,560). Main outcome measures were SMM defined by the Center for Disease Control and Prevention (20 indicators), assessed with multivariable generalized linear model. Secondary outcomes included hypertensive crisis.

Results:
Compared to White patients, Black (adjusted-incidence rate ratio [aIR] 1.80, 95% confidence interval [CI] 1.70-1.91), Asian (aIR 1.85, 95%CI 1.68-2.04), and Hispanic (aIR 1.33, 95%CI 1.25-1.41) patients had higher rates of any SMM. When assessed for the extent of SMM indicators, the likelihood of having triple or more SMM indicators among Asian (aIR 2.82, 95%CI 2.43-3.27), Hispanic (aIR 2.30, 95%CI 2.11-2.51) or Black (aIR 2.28, 95%CI 2.54-3.03) patients, exceeded two-fold compared to Whites. When comparing individual morbidity to White patients, Black subjects were more likely to have ventilation needs, cardiac morbidity, and cerebrovascular accident; Hispanic subjects were more likely to have cardiac morbidity, shock, and sepsis; and Asian subjects were more likely to have shock, sepsis, cardiac morbidity, and ventilation needs (all, aIR >2.50). In addition, Black (aIR 3.17, 95%CI 2.63-3.82) and Hispanic (aIR 2.74, 95%CI 2.26-3.32) patients had two times higher rates of hypertensive crisis compared to White patients.

Conclusion:
Among patients who had HELLP syndrome, the extent and severity of SMM was greater for Blacks, Hispanics and Asians compared to Whites. The substantial racial and ethnic disparities in SMM warrant future investigation to understand and mitigate these inequalities.