Trends and outcomes for deliveries with hypertensive disorders of pregnancy from 2000 to 2018: A repeated cross‐sectional study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 129; no. 7; pp. 1050 - 1060
• Main Authors: Wen, Timothy, Schmidt, Christina N., Sobhani, Nasim C., Guglielminotti, Jean, Miller, Eliza C., Sutton, Desmond, Lahtermaher, Yael, D’Alton, Mary E., Friedman, Alexander M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2022
• Subjects: Acute Kidney Injury - epidemiology; Cross-Sectional Studies; Female; Hospitalization; Humans; Hypertension; Hypertension, Pregnancy-Induced - epidemiology; hypertensive disorders of pregnancy; Kidneys; Liver diseases; maternal safety; Pre-Eclampsia; Preeclampsia; Pregnancy; Prevalence; Regression analysis; Renal failure; Risk factors; severe maternal morbidity; Stroke; Stroke - epidemiology; Trends; United States > US; pre-eclampsia; severe maternal morbidity; hypertensive disorders of pregnancy; maternal safety
• ISSN: 1470-0328; 1471-0528; 1471-0528
• DOI: 10.1111/1471-0528.17038

Objective To analyse trends, risk factors, and outcomes related to hypertensive disorders of pregnancy (HDP). Design Repeated cross‐sectional. Setting US delivery hospitalisations. Population Delivery hospitalisations in the 2000–2018 National Inpatient Sample. Methods US hospital delivery hospitalisations with HDP were analysed. Several trends were analysed: (i) the proportion of deliveries by year with HDP, (ii) the proportion of deliveries with HDP risk factors and (iii) adverse outcomes associated with HDP including maternal stroke, acute renal failure and acute liver injury. Risk ratios were determined using regression models with HDP as the exposure of interest. Main Outcome Measures Prevalence of HDP, risk factors for HDP and associated adverse outcomes. Results Of 73.1 million delivery hospitalisations, 7.7% had an associated diagnosis of HDP. Over the study period, HDP doubled from 6.0% of deliveries in 2000 to 12.0% in 2018. The proportion of deliveries with risk factors for HDP increased from 9.6% in 2000 to 24.6% in 2018. In adjusted models, HDP were associated with increased stroke (aRR [adjusted risk ratio] 15.9, 95% CI 14.8–17.1), acute renal failure (aRR 13.8, 95% CI 13.5–14.2) and acute liver injury (aRR 1.2, 95% CI 1.2–1.3). Among deliveries with HDP, acute renal failure and acute liver injury increased; in comparison, stroke decreased. Conclusion Hypertensive disorders of pregnancy increased in the setting of risk factors for HDP becoming more common, whereas stroke decreased. Tweetable While hypertensive disorders of pregnancy increased from 2000 to 2018, stroke appears to be decreasing. Tweetable While hypertensive disorders of pregnancy increased from 2000 to 2018, stroke appears to be decreasing. Linked article This article is commented on by Miriam F. van Oostwaard, pp. 1061 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17091.