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

Abstract

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 abstract: While hypertensive disorders of pregnancy increased from 2000 to 2018, stroke appears to be decreasing.

Keywords: hypertensive disorders of pregnancy; maternal safety; pre-eclampsia; severe maternal morbidity.