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Grand Rounds

Latest US Trends: Incidence of Hypertensive Disorders of Pregnancy Continues to Increase

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BACKGROUND AND PURPOSE:

  • Bruno et al. (Obstetrics and Gynecology, 2022) evaluated national trends in hypertensive disorders of pregnancy (HDP), chronic hypertension and eclampsia using vital statistics data

METHODS:

  • Repeated cross-sectional analysis
    • Data derived from the National Vital Statistics System (NVSS), from 1989 to 2020
  • Population
    • Singleton pregnancies
    • Delivered >20 weeks
  • Definitions
    • Hypertensive disorders of pregnancy: Increase in blood pressure in pregnancy inclusive of hypertensive disorders of pregnancy, preeclampsia, eclampsia, and HELLP syndrome
    • Chronic hypertension: Blood pressure elevation before pregnancy
    • Eclampsia as any hypertension with generalized seizures or coma
  • Primary outcomes
    • Temporal trends in HDP, chronic hypertension, and eclampsia

RESULTS:

  • Overall 122,329,914 deliveries
    • Cesarean: 26%
    • Nulliparous: 40%
    • Obesity: 26%
    • Mean maternal age: 28 years

Proportion of deliveries associated with HDP and chronic hypertension increased significantly over the study period

  • HDP
    • 1989: 2.79% of pregnancies
    • 2020: 8.22% of pregnancies
    • Average annual percentage change: 3.6% (95% CI, 3.0 to 4.1)
  • Chronic hypertension
    • Average annual percentage change: 4.1% (95% CI 3.3 to 4.9)

Proportion of deliveries associated with eclampsia declined significantly over the study period

  • Eclampsia
    • 1989: 0.42%
    • 2020: 0.27%
    • Average annual percentage change: −2.5% (95% CI, −4.0 to −1.0)

Limited to 2016 to 2022

  • Similar trends noted for HDP and chronic hypertension
  • Decreasing trends for eclampsia were no longer significant

Nulliparity

  • Results did not differ when analyses restricted to nulliparous individuals

CONCLUSION:

  • The incidence of pregnancies complicated by HDP and chronic hypertension is increasing, while the rate of eclampsia decreased
  • The authors state

It is unknown whether clinical practice changes or population-level risk factors altered these rates

Nonetheless, it is concerning that rates of hypertensive disorders continue to increase given the associated maternal morbidity and mortality

Learn More – Primary Sources:

Trends in Hypertensive Disorders of Pregnancy in the United States From 1989 to 2020

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Related ObG Topics:

Does Hypertension in Pregnancy Predict Hypertension Later in Life?
Maternal Risk Factors and Complication Trends Over the Past Three Decades
Does a Single Elevated Blood Pressure Before 20 Weeks Increase the Risk for Preeclampsia?

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