Hypertensive disorders during pregnancy (HDP), including pre-existing hypertension and pregnancy-induced hypertension, affect 10-20% of pregnancies globally and pose significant risks for adverse maternal and neonatal outcomes.1 From 1990 to 2021, the global incidence of these conditions rose from 31.3 million to 36.1 million, reflecting a 15.2% increase.2

In the United States, nearly half of the women aged 20 and older have some form of cardiovascular disease, and fewer than half enter pregnancy with optimal cardiovascular health.3 Over time, cardiovascular health among women has declined, with pregnant women experiencing worse outcomes than their nonpregnant counterparts. This decline is largely driven by the increasing prevalence of risk factors such as advanced maternal age at first pregnancy, obesity, and other cardiometabolic conditions.4 Additionally, gender disparities persist in hypertension management, with women being less likely than men to receive antihypertensive treatment at comparable blood pressure levels.5

The severity of HDP—progressing from stable chronic hypertension to exacerbated chronic hypertension and superimposed preeclampsia—correlates with an increased risk of adverse neonatal outcomes.6 Chronic hypertension in women is particularly concerning, as it can significantly increase the risk of perinatal mortality.7 This heightened risk persists even when accounting for coexisting conditions such as preeclampsia, fetal growth restriction, or gestational diabetes.8

Despite advancements in healthcare, racial disparities in maternal and neonatal outcomes remain stark. Women of color experience disproportionately high rates of HDP and their associated complications. This may be linked to both biological factors, such as an elevated baseline risk of cardiovascular disease, and socio-economic factors like limited healthcare access, systemic discrimination, and inadequate prenatal care.9,10 Among those with hypertension, women of color also face significantly worse pregnancy outcomes, including higher rates of preterm birth, small-for-gestational-age infants, and increased infant mortality.11

This study utilizes data from the CDC WONDER Natality database (2016 ‒ 2022) to examine neonatal outcomes among hypertensive women across different racial and ethnic backgrounds. Through detailed statistical analyses of neonatal intensive care unit (NICU) admissions, low birth weight, neonatal assisted ventilation, and neonatal in-hospital mortality, this research aims to provide a comprehensive assessment of the impact of HDP on neonatal health. While previous studies have documented disparities in HDP and neonatal outcomes, this study offers a novel contribution by utilizing a comprehensive, population-level, multi-year dataset that allowed us to compare risks across all major racial/ethnic groups and U.S. regions, revealing where disparities are greatest and where targeted interventions could have the most impact on maternal and newborn health.