PROJECT SUMMARY Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and preeclampsia, are increasing yearly across the United States with a persistent racial inequity in prevalence and consequent morbidity. Black birthing people are more likely to develop preeclampsia, more likely to suffer a severe maternal morbidity, and more likely to develop cardiovascular disease compared to White counterparts. There is growing evidence that health-related social needs, such as housing instability, contribute to this inequity. While non-U.S. nativity imparts a protective effect against adverse pregnancy outcomes and chronic disease, a finding deemed the “immigrant paradox,” there is emerging evidence that it does not protect against racial inequities in pregnancy outcomes, including a higher rate of preterm birth and hypertensive disorders of pregnancy among Black, non-U.S. born mothers compared to White non-U.S. born mothers. Over the past several years, there has been a shifting demographic of migrants arriving in the U.S., with unprecedented numbers traversing the U.S.-Mexico border under arduous conditions, prompting the need to examine the impact of nativity on inequities in outcomes related to hypertensive disorders of pregnancy. This project will examine inequities by nativity in postpartum outcomes at a large safety-net hospital with a diverse patient population that is 40% Black, 40% Hispanic, and 60% foreign born. Our proposal will use electronic medical record data on 6,000 deliveries with hypertensive disorders of pregnancy occurring from 2017-2023 and proposes a novel assessment of health-related social needs using algorithms informed by screening tools, social work contacts, and referral letters, to conduct the following aims: (1) examine disparities by nativity in postpartum cardiovascular related outcomes, including hypertension and repeat hypertensive disorders of pregnancy, (2) assess mediation between nativity and postpartum cardiovascular related outcomes by various constructs of health-related social needs, such as housing instability. The ultimate goal of this research is to harness an existing data in the medical record and use an intersectionality framework to conduct an in-depth examination of disparities by nativity and intersections of nativity with race and ethnicity. Furthermore, in alignment with the parent award (R01-HL158864) examining cardiovascular related severe maternal morbidity, this administrative supplement will generate evidence that is critical in understanding postpartum outcomes in the face of a changing demographic experienced at an urban, safety-net hospital that mirrors nationwide trends.