Hemolysis predisposes to adverse pregnancy outcomes. Yet, there are limited data on hemolysis in hypertensive disorders of pregnancy other than hemolysis, elevated liver enzymes, and low platelet count syndrome. To evaluate the prevalence and impact of hemolysis in hypertensive disorders of pregnancy, we performed a retrospective cohort study at a single center (October 2013-May 2017), among women screened for hemolysis using lactate dehydrogenase (LDH) levels. We compared LDH levels by hypertensive disorder (chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia with severe features) and evaluated impact on adverse pregnancy outcomes. Data were analyzed by χ or test, ANOVA, test of medians, and logistic regression. Among 8645 deliveries, 1188 (13.7%) had a hypertensive disorder. Of these, 812 (68.4%) had LDH measurement before delivery: chronic hypertension (n=152); gestational hypertension (n=209); preeclampsia (n=216); and preeclampsia with severe features (n=235). LDH ≥400 U/L (≥1.6× normal) was more common in preeclampsia with severe features compared with other hypertensive disorders of pregnancy (9.8% versus 2.3%;<0.001); adjusted odds ratio 4.52 (95% confidence interval, 2.2-9.2; <0.001). LDH ≥400 U/L was associated with adverse maternal outcomes (41.7% versus 15.3%; <0.001), adjusted odds ratio 3.05 (95% confidence interval, 1.4-6.7; =0.006), and adverse neonatal outcomes (eg, preterm birth 59.4% versus 22.5%;<0.001). We find that elevated LDH levels are associated with adverse maternal and neonatal outcomes in hypertension and preeclampsia, independent of hemolysis, elevated liver enzymes, and low platelet count syndrome. Therefore, elevated LDH levels (≥1.6× normal or ≥400 U/L) may be considered a severe feature of preeclampsia.
Medicaid was not associated with a particular hypertensive disorder in pregnancy, yet those with Medicaid experienced more severe BP elevations and higher rates of adverse neonatal outcomes. More research is needed to understand potential risk factors and ways to improve outcomes for those with publicly funded insurance.
INTRODUCTION: It is unclear if women with chronic hypertension (CHTN) and superimposed preeclampsia (siPE) have more severe disease than women with preeclampsia (PE) without CHTN. We sought to compare disease features and outcomes in these groups. METHODS: Retrospective cohort study (Oct'13 - May'17) at a single institution, among subjects with hypertensive disease in pregnancy, delivered ≥23 weeks gestation, who were screened using ICD-9 and ICD-10 codes with subsequent chart validation. Subjects were divided: 1) CHTN; 2) Gestational hypertension (GHTN); 3) PE and, 4) PE with severe features (PE-SF). Those with siPE were placed in Group 3 or 4, as determined by labs or symptom criteria. Differences were assessed by Chi-square, Fisher exact or Student t-test. RESULTS: Among 1,188 pregnancies with a hypertensive disorder, 626 developed PE; of which 140 (22.4%) had siPE. CHTN was more common in PE-SF than PE without SF (29.3% vs. 15.2%, P<.001). Compared to women with PE, those with siPE were more likely to have severe headache (30.9 vs. 18.5%, p=0.002) and pulmonary edema (5.7 vs. 1.7%, P.007). Other severe features of PE were similar regardless of CHTN including thrombocytopenia, elevated liver enzymes, kidney injury, and eclampsia. Those with CHTN and siPE were more likely to have preterm neonates (53.0 vs. 24.6%) P<.001) with respiratory distress syndrome (RDS) (30.3 vs. 13.5%, P<.001). CONCLUSION: Women with CHTN and siPE have more severe disease than women with PE alone. Notably, siPE is associated with more headache, pulmonary edema, preterm delivery, and RDS
INTRODUCTION: Opioid use in pregnancy is increasing dramatically and is associated with poor maternal and neonatal outcomes. We sought to evaluate the relationship between opioid use and pregnancy outcomes among women with hypertensive disorders in pregnancy. METHODS: Retrospective cohort study among subjects with a hypertensive disorder of pregnancy that delivered ≥23 weeks gestation at a single institution (October '13-April '18). After IRB approval, subjects were stratified into two groups by opioid use (heroin, methadone or Subutex): current vs. non-users (never, quit prior to or during pregnancy). Differences were analyzed by Fisher's exact, t-test, and logistic regression, with α=0.05. RESULTS: From 10,833 deliveries, 1,487 (13.7%) were classified with a hypertensive disorder of pregnancy. 41 subjects (2.8%) actively used opioids during pregnancy, 1,098 (73.8%) were non-users and 348 (23.4%) were excluded due to unknown opioid use. Subjects using opioids were more likely to be covered by public insurance and using other substances. There were no differences in final hypertensive diagnosis for opioid users vs. non-users (p=0.26), although opioid users more often had severe diastolic blood pressure (≥110 mmHg) compared to non-users (p=0.012). Opioid use was associated with both adverse maternal and neonatal outcomes, which remained significant after adjustment for maternal characteristics and other substance use (aOR: 2.99, p=0.033 and aOR: 3.13, p=0.009, respectively). CONCLUSION: Among women with a hypertensive disorder of pregnancy, opioid use is associated with a 2-3 times increased odds for both adverse maternal and neonatal outcomes compared to non-users. These findings highlight the need to limit opioid use in pregnancy.
sought to examine if race is associated with postpartum readmission due to hypertension in women with pregnancy-associated hypertension. STUDY DESIGN: This was a multi-institutional retrospective cohort study of all women with pregnancy-associated hypertension diagnosed prior to initial discharge from January 2009 to December 2016. Pregnancy-associated hypertension such as gestational hypertension and preeclampsia (with or without severe features) was diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions. Women with chronic hypertension and superimposed pre-eclampsia were excluded. Postpartum readmission due to hypertension was defined as a readmission due to severe hypertension within 6 weeks postpartum. Outcomes including age, gestational age, race/ethnicity (self-reported), body mass index (kg/m 2), marital status, type of pregnancy-associated hypertension, diabetes (gestational or pregestational), use of antihypertensive drugs, mode of delivery, and others were utilized in the comparison. Multivariable logistic regression models were performed to calculate adjusted odds ratios (OR) and 95% confidence interval (95%CI). RESULTS: Of 4,949 women with pregnancy-associated hypertension before initial discharge, 71 (1.4%) had postpartum readmission due to hypertension. Women with postpartum readmission due to hypertension compared to those without were more likely to be older (P <. 001) (Table 1). Other outcomes were comparable. After adjusting for confounders, women with postpartum readmission due to hypertension compared to those without were more likely to be older (adjusted OR 1.04; 95%CI 1.00-1.09) and non-Hispanic black (adjusted OR 2.31; 95%CI 1.05-5.08; non-Hispanic white as referent) (Table 2) CONCLUSION: In women with pregnancy-associated hypertension before initial discharge, non-Hispanic black women were at increased odds of postpartum readmission due to hypertension. Further studies are required to reduce racial disparities in postpartum readmission due to hypertension.
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