Sociodemographic, Clinical, and Mental Health Predictors of Maternal Hypertension by PRAMS 2020–2022

Abstract Introduction Maternal hypertension (HBP) is a significant risk factor for adverse pregnancy outcomes. This study examines the sociodemographic, clinical, and mental health predictors of maternal HBP using logistic regression analysis on Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 data. Materials and methods This cross-sectional analysis utilized the Pregnancy Risk Assessment Monitoring System (PRAMS) 2020 to 2022 (n = 27,947). Logistic regression models were used to examine associations between maternal hypertension and various predictors, including maternal clinical factors (low birth weight (LBW), small for gestational age (SGA), preterm birth history), mental health conditions (anxiety, depression), and demographic characteristics (maternal age, education, race/ethnicity, WIC participation). Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to identify significant predictors. Results Maternal age showed a strong positive association with HBP, with women aged 40+ having the highest risk (aOR = 4.58; 95% CI: 3.09-6.80). Non-Hispanic Black mothers had significantly higher odds of HBP compared to White mothers (aOR = 2.11; 95% CI: 1.83-2.44). WIC participation was positively associated with HBP (aOR = 1.19; 95% CI: 1.05-1.34). LBW (aOR = 1.49; 95% CI: 1.24-1.79), SGA (aOR = 1.49; 95% CI: 1.24-1.79), and preterm birth history (aOR = 1.64; 95% CI: 1.38-1.96) increased HBP risk. Mental health factors were significant predictors; anxiety (aOR = 1.73; 95% CI: 1.51-1.99) and depression (aOR = 2.98; 95% CI: 2.58-3.43) independently elevated HBP risk. Conclusions Sociodemographic disparities, LBW, SGA, preterm birth history, and mental health factors are critical contributors to maternal hypertension risk. Targeted interventions addressing racial disparities and integrating mental health support into prenatal care may reduce HBP prevalence and improve maternal outcomes across diverse populations. Key messages • Maternal hypertension is strongly associated with advanced age, racial disparities (e.g., higher risk among non-Hispanic Black mothers), and mental health conditions like anxiety and depression. • Maternal clinical factors such as LBW, SGA, and preterm birth history significantly increase maternal hypertension risk, highlighting the need for targeted interventions in prenatal care.