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Grand Rounds

How Much Does Prevalence of Eclampsia and Other Hypertensive Disorders Vary by State?

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BACKGROUND AND PURPOSE:

  • Butwick et al. (JAMA Network Open, 2020) assessed the extent of statewide variation in the prevalence of chronic hypertension and hypertensive disorders of pregnancy

METHODS:

  • Cross-sectional study (September 1, 2019 to February 1, 2020)
  • Data source
    • 2017 US birth certificate data
  • Population
    • Women with a live birth delivery
  • Study design
    • Multivariable logistic regression with median odds ratio (MOR) was used to evaluate statewide variation
  • Primary outcomes
    • State-specific prevalence of
      • Chronic hypertension
      • Hypertensive disorders of pregnancy (including pregnancy-induced hypertension and preeclampsia)
      • Eclampsia

RESULTS:

  • 3,659,553 women included in the cohort
  • Age demographics
    • <20 years: 5.1%
    • 20 to 24 years: 19.9%
    • 25 to 29 years: 29.2%
    • 30 to 34 years: 28.3%
    • 35 to 39 years: 14.3%
    • ≥40 years: 3.2%
  • Medical insurance status
    • Medicaid: 42.8%
    • Private insurance: 49.4%
  • Chronic hypertension
    • Lowest adjusted prevalence: Hawaii 1.0% (95% CI, 0.9% to 1.2%)
    • Highest adjusted prevalence: Alaska 3.4% (95% CI, 3.0% to 3.9%)
  • Hypertensive disorders of pregnancy
    • Lowest adjusted prevalence: Massachusetts 4.3% (95% CI, 4.1% to 4.6%)
    • Highest adjusted prevalence: Louisiana 9.3% (95% CI, 8.9% to 9.8%)
  • Eclampsia
    • Lowest adjusted prevalence: Delaware 0.03% (95% CI, 0.01% to 0.09%)
    • Highest adjusted prevalence: Hawaii 2.8% (95% CI, 2.2% to 3.4%)
  • The degree of statewide variation was high for eclampsia
    • MOR 2.36 (95% CI, 1.88 to 2.82)
  • Variation was more modest between states for
    • Chronic hypertension: MOR 1.27 (95% CI ,1.20 to 1.33)
    • Hypertensive disorders of pregnancy: MOR 1.17 (95% CI, 1.13 to 1.21)

CONCLUSION:

  • The prevalence of eclampsia varies by state to a substantial degree
    • The median odds ratio was 2.4-fold higher if the same woman delivered in a US state with a higher vs lower prevalence of eclampsia
  • The authors suggest that

These data can inform future public health inquiries to identify reasons for the state-level variability in eclampsia prevalence

Learn More – Primary Sources:

Evaluation of US State–Level Variation in Hypertensive Disorders of Pregnancy

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Related ObG Topics:

Eclampsia and Role of Magnesium Sulfate
Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines
ACOG Preeclampsia Guidelines: Antenatal Management and Timing of Delivery
Neuraxial Analgesia: What is the Statewide Variation in Usage?
Delivery vs Expectant Management for Hypertensive Disorders in Pregnancy

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