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. 2022 Jan 4;5(1):e2142343.
doi: 10.1001/jamanetworkopen.2021.42343.

Estimated Prevalence of Risk Factors for Preeclampsia Among Individuals Giving Birth in the US in 2019

Sarahn M Wheeler  1 , Sabrena O Myers  2 , Geeta K Swamy  1 , Evan R Myers  3
Affiliations

Estimated Prevalence of Risk Factors for Preeclampsia Among Individuals Giving Birth in the US in 2019

Sarahn M Wheeler et al. JAMA Netw Open. .

Abstract

Importance: Low-dose aspirin (LDA) is one of the few evidence-based interventions for preventing preeclampsia, which is a leading cause of maternal or fetal morbidity and mortality. Current guidelines recommend LDA based on the presence of risk factors for preeclampsia, but the population-based prevalence of these factors is unknown.

Objective: To estimate population-level prevalence of preeclampsia risk factors used in prophylactic LDA guidelines for pregnant patients and the association of these risk factors with reported rates of pregnancy-related hypertension.

Design, setting, and participants: A retrospective cohort study was conducted using National Center for Health Statistics birth certificate data to describe the frequency of pregnant individuals with moderate to high-risk factors for preeclampsia and pregnancy-related hypertension rates. The study used all birth records in the United States for the 2019 calendar year.

Exposures: Documentation of preeclampsia risk factors: multifetal gestation, pregestational diabetes, chronic hypertension (high-risk factors) and nulliparity, a body mass index greater than 30, African American race, a maternal age 35 years or older, an interval of more than 10-years since last birth, and having low socioeconomic status (moderate risk factors).

Main outcomes and measures: Prevalence of each risk factor alone and in combinations leading to a recommendation for LDA; incidence of pregnancy-related hypertension by risk factor and combinations of risk factors.

Results: There were 3 695 019 pregnancies in 2019, including 528 778 with no risk factors, 169 540 with 1 or more high-risk factors, and 2 996 701 with 1 or more moderate-risk factors. The mean (SD) of the cohort was 29.1 (5.8) years. Multifetal gestation was the most common high-risk factor and found in 123 995 pregnancies (3.4%), and low socioeconomic status was the most common moderate-risk factor and present in 1 732 729 pregnancies (46.9%). Based on 2021 criteria (a single high- or moderate-risk factors for preeclampsia), 3 166 241 pregnant patients (85.7%) were eligible for LDA. The incidence of pregnancy-related hypertension increased with the number of moderate-risk factors. The 2021 guidelines suggest considering or recommend LDA in 92.3% of pregnancies diagnosed with pregnancy-related hypertension.

Conclusions and relevance: These data support the recently published guidelines and suggest further simplified guidelines recommending LDA to patients with any single moderate-risk factors.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Swamy reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Institute of Allergy and Infectious Diseases, receiving personal fees from GlaxoSmithKline, Pfizer, and UpToDate Chair, and receiving grants from the Centers for Disease Control and Prevention outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Preeclampsia Risk Factors and Gestational Hypertension (HTN) and Eclampsia Outcomes
See this image and copyright information in PMC

References

    1. Henderson JT, Vesco KK, Senger CA, Thomas RG, Redmond N. Aspirin use to prevent preeclampsia and related morbidity and mortality: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;326(12):1192-1206. doi: 10.1001/jama.2021.8551 - DOI - PubMed
    1. Henderson JT, Whitlock EP, O’Connor E, Senger CA, Thompson JH, Rowland MG. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the US Preventive Services Task Force. Ann Intern Med. 2014;160(10):695-703. doi: 10.7326/M13-2844 - DOI - PubMed
    1. Ayansina D, Black C, Hall SJ, et al. Long-term effects of gestational hypertension and pre-eclampsia on kidney function: record linkage study. Pregnancy Hypertens. 2016;6(4):344-349. doi: 10.1016/j.preghy.2016.08.231 - DOI - PMC - PubMed
    1. LeFevre ML; U.S. Preventive Services Task Force . Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(11):819-826. doi: 10.7326/M14-1884 - DOI - PubMed
    1. Werner EF, Hauspurg AK, Rouse DJ. A cost-benefit analysis of low-dose aspirin prophylaxis for the prevention of preeclampsia in the United States. Obstet Gynecol. 2015;126(6):1242-1250. doi: 10.1097/AOG.0000000000001115 - DOI - PubMed

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