Signs or symptoms of suspected preeclampsia - A retrospective national database study of prevalence, costs, and outcomes

Kavia Khosla; Yue Jin; Jimmy Espinoza; Matthew Kent; Mikael Gencay; Liza H Kunz; Ariel Mueller; Yan Xiao; W Frank Peacock; Sean-Xavier Neath; Jennifer J Stuart; Douglas Woelkers; James M Harris; Sarosh Rana

doi:10.1016/j.preghy.2024.101124

Signs or symptoms of suspected preeclampsia - A retrospective national database study of prevalence, costs, and outcomes

Pregnancy Hypertens. 2024 Apr 11:36:101124. doi: 10.1016/j.preghy.2024.101124. Online ahead of print.

Authors

Kavia Khosla¹, Yue Jin², Jimmy Espinoza³, Matthew Kent⁴, Mikael Gencay², Liza H Kunz⁵, Ariel Mueller⁶, Yan Xiao⁵, W Frank Peacock⁷, Sean-Xavier Neath⁸, Jennifer J Stuart⁹, Douglas Woelkers¹⁰, James M Harris², Sarosh Rana¹¹

Affiliations

¹ University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
² Roche Diagnostics, Indianapolis, IN, USA.
³ Department of Obstetrics and Gynecology, Division of Fetal Intervention, McGovern Medical School at the University of Texas Health Science Center Houston, and UT Physicians, The Fetal Center, Affiliated with Children's Memorial Hermann Hospital, TX, USA.
⁴ Department of Epidemiology and Biostatistics, Genesis Research, Hoboken, NJ, USA.
⁵ Roche Diagnostics Systems, San Jose, CA, USA.
⁶ University of Chicago Pritzker School of Medicine, Chicago, IL, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
⁸ Department of Emergency Medicine, Gynecology and Reproductive Science, University of California, La Jolla, CA, USA.
⁹ Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁰ Department of Obstetrics, Gynecology and Reproductive Science, University of California, La Jolla, CA, USA.
¹¹ Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, Chicago, IL, USA. Electronic address: srana@bsd.uchicago.edu.

PMID: 38608393
DOI: 10.1016/j.preghy.2024.101124

Abstract

Background: Most patients with signs or symptoms (s/s) of suspected preeclampsia are not diagnosed with preeclampsia. We sought to determine and compare the prevalence of s/s, pregnancy outcomes, and costs between patients with and without diagnosed preeclampsia.

Methods: This retrospective cohort study analyzed a large insurance research database. Pregnancies with s/s of preeclampsia versus a confirmed preeclampsia diagnosis were identified using International Classification of Diseases codes. S/s include hypertension, proteinuria, headache, visual symptoms, edema, abdominal pain, and nausea/vomiting. Pregnancies were classed as 1) s/s of preeclampsia without a confirmed preeclampsia diagnosis (suspicion only), 2) s/s with a confirmed diagnosis (preeclampsia with suspicion), 3) diagnosed preeclampsia without s/s recorded (preeclampsia only), and 4) no s/s, nor preeclampsia diagnosis (control).

Results: Of 1,324,424 pregnancies, 29.2 % had ≥1 documented s/s of suspected preeclampsia, and 14.2 % received a preeclampsia diagnosis. Hypertension and headache were the most common s/s, leading 20.2 % and 9.2 % pregnancies developed to preeclampsia diagnosis, respectively. Preeclampsia, with or without suspicion, had the highest rates of hypertension-related severe maternal morbidity (HR [95 % CI]: 3.0 [2.7, 3.2] and 3.6 [3.3, 4.0], respectively) versus controls. A similar trend was seen in neonatal outcomes such as preterm delivery and low birth weight. Cases in which preeclampsia was suspected but not confirmed had the highest average total maternal care costs ($6096 [95 % CI: 602, 6170] over control).

Conclusion: There is a high prevalence but poor selectivity of traditional s/s of preeclampsia, highlighting a clinical need for improved screening method and cost-effectiveness disease management.

Keywords: Diagnosis; Evaluation; Healthcare costs; Healthcare outcomes; Preeclampsia; Risk stratification.