CDC MMW Reports: Update on Hypertensive Disorders of Pregnancy in the US (2017 to 2019)?
BACKGROUND AND PURPOSE:
Ford et al. (CDCMMWR, 2022) calculated the annual prevalence of hypertensive disorders of pregnancy (HDP) among delivery hospitalizations in the US and the percentage of in-hospital deaths associated with HDP
Population cohort study
Delivery hospitalizations in the US from 2017 to 2019
Data derived from the National Inpatient Sample| A nationally representative sample of all US hospital discharges
Overall HDP data assessed for the following
Selected maternal characteristics: Age group | Race and ethnicity | Primary payer at delivery hospitalization
Characteristics of the community: County-level rural-urban classification | Zip code–level median household income | Hospital region
Weighted annual prevalence (percentage)
Overall, prevalence of HDP among delivery hospitalizations increased from 2017 to 2019
The prevalence for different types of HDP also increased
Prevalence of HDP was highest among the following
Non-Hispanic Black or African American (Black) women
Non-Hispanic American Indian and Alaska Native (AI/AN) women
Zip codes in the lowest median household income quartile
Delivering in hospitals in the South or the Midwest Census regions
Death Associated with HDP
Among all deaths that occurred during delivery hospitalization, HDP was documented in: 31.6%
HDP complicated ~15% of US all delivery hospitalizations in 2019, a figure that has increased since 2017
Older women, Non-Hispanic Black and Native women, and women living in poorer zip codes had the highest HDP prevalence
Limitations include use of coding data and reporting bias
The authors state
The prevalence of HDP increased during the 3-year study period with noted racial and ethnic, sociodemographic, and place-based disparities
Severe HDP-associated maternal complications and mortality are preventable with equitable implementation of public health and clinical strategies
These include efforts across the life course for preventing HDP, identifying, monitoring, and appropriately treating those with HDP with continuous and coordinated care, increasing awareness of urgent maternal warning signs, and implementing quality improvement initiatives to address severe hypertension
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