The association between hypertensive disorders during pregnancy and maternal and neonatal outcomes: a retrospective claims analysis

Abstract

Background Hypertensive disorders during pregnancy continue to increase in prevalence and are associated with several adverse outcomes and future cardiovascular risk for mothers. This study evaluated the association of hypertensive disorders compared to no hypertension during pregnancy with neonatal and maternal outcomes. We then evaluated risk factors associated with progression from a less to more severe hypertensive disorder during pregnancy. Methods We conducted a propensity-matched retrospective cohort study utilizing Medicaid claims data from a national insurer. The study population consisted of mothers with and without hypertensive disorders who delivered between 7/1/2016–12/31/2018 and their infants. Hypertensive disorders included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Propensity score matching was used to match mothers without to those with hypertensive disorders. Regression models were used to compare maternal and neonatal outcomes. Stepwise logistic regression was used to determine characteristics associated with the progression of gestational hypertension to preeclampsia or chronic hypertension to superimposed preeclampsia. Results We observed the highest risk of cesarean delivery (odds ratio [OR]:1.61 and 1.99) in mothers and preterm delivery (OR:2.22 and 5.37), respiratory distress syndrome (OR:2.39 and 4.19), and low birthweight (OR:3.64 and 9.61) in babies born to mothers with preeclampsia or superimposed preeclampsia compared to no hypertension, respectively (p < 0.05 for all outcomes). These outcomes were slightly higher among chronic or gestational hypertension compared to no hypertension, however, most were not statistically significant. Risk of neonatal intensive care unit utilization was higher among more severe hypertensive disorders (OR:2.41 for preeclampsia, OR:4.87 for superimposed preeclampsia). Obesity/overweight and having a history of preeclampsia during a prior pregnancy were most likely to predict progression from gestational/chronic hypertension to preeclampsia/superimposed preeclampsia. Conclusion Mothers and neonates born to mothers with preeclampsia or superimposed preeclampsia experienced more adverse outcomes compared to those without hypertension. Mothers and neonates born to mothers with gestational hypertension had outcomes similar to those without hypertension. Outcomes for those with chronic hypertension fell in between gestational hypertension and preeclampsia. Obesity/overweight and having a history of preeclampsia during a prior pregnancy were strong risk factors for hypertension progression.

Preeclampsia and the Associated Risk Factors Among Pregnant Women in Indonesia: a Literature Review

“…It is information that can add to the description of the disease now and or that influences the management of the patient. Many factors cause an increased incidence of preeclampsia in pregnant women, including a history of chronic hypertension, diabetes mellitus or kidney disease [58]. Pregnancy-induced hypertension, like preeclampsia, is one of the primary causes of death.…”

“…More severe hypertension diseases were associated with a higher risk of using a newborn intensive care unit (OR:2.41 for preeclampsia, OR:4.87 for superimposed preeclampsia). The two factors most likely to predict the progression from gestational or chronic hypertension to preeclampsia or superimposed preeclampsia were obesity or overweight and a history of preeclampsia during a previous pregnancy [58].…”

The Association Between Smoking During Pregnancy and Hypertensive Disorders of Pregnancy : A Systematic Review

“…Bromfield, SG et al (2023) 7 showed mothers and neonates born to mothers with preeclampsia or superimposed preeclampsia experienced more adverse outcomes compared to those without hypertension. Mothers and neonates born to mothers with gestational hypertension had outcomes similar to those without hypertension.…”