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. 2022 Jul 1;140(1):83-86.
doi: 10.1097/AOG.0000000000004824. Epub 2022 Jun 7.

Trends in Hypertensive Disorders of Pregnancy in the United States From 1989 to 2020

Ann M Bruno  1 , Amanda A Allshouse, Torri D Metz, Lauren H Theilen
Affiliations

Trends in Hypertensive Disorders of Pregnancy in the United States From 1989 to 2020

Ann M Bruno et al. Obstet Gynecol. .

Abstract

Hypertensive disorders of pregnancy affect up to 8% of pregnancies, but updated national trends are lacking. We performed a repeated cross-sectional analysis of individuals with singleton pregnancies who delivered at greater than 20 weeks of gestation, with data in the U.S. National Vital Statistics System from 1989 to 2020. Temporal trends in hypertensive disorders of pregnancy, chronic hypertension, and eclampsia were characterized using joinpoint regression. Overall, 122,329,914 deliveries were included. Hypertensive disorders of pregnancy increased from 2.79% in 1989 to 8.22% in 2020, representing an average annual percentage change (AAPC) of 3.6% (95% CI 3.0-4.1%). Chronic hypertension increased (AAPC 4.1%, 95% CI 3.3-4.9%), whereas eclampsia decreased (AAPC -2.5%, 95% CI -4.0% to -1.0%). Hypertensive disorders of pregnancy are associated with significant morbidity and mortality; the rising incidence is concerning.

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Conflict of interest statement

Financial Disclosure Torri D. Metz has received UpToDate royalties for two topics on trial of labor after cesarean. Money was paid to her institution from Gestvision as she was a site PI for a preeclampsia point-of-care test, and her institution received money to conduct the study (ended August 2020). Money was paid to her institution from Pfizer as she is a site PI for a phase III respiratory syncytial virus (RSV) vaccine trial, and her institution received money to the conduct study (current). She is a member of Pfizer's Medical Advisory Board (1/15/2021) and site PI for a COVID-19 vaccination trial in pregnancy. She serves on the Society for Maternal-Fetal Medicine Board of Directors. The other authors did not report any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Trends in hypertensive disorders of pregnancy, chronic hypertension, and eclampsia among singleton deliveries in the U.S. from 1989 to 2020 (A) Trends in hypertensive disorders of pregnancy and chronic hypertension in the U.S. from 1989 to 2020 among singleton deliveries. The figure demonstrates the rate of hypertensive disorders of pregnancy and chronic hypertension over time. There was a significant 3.6% annual increase in the rate of hypertensive disorders of pregnancy (average annual percent change [AAPC] 3.6%, 95% CI 3.0% to 4.1%) and a significant 4.1% annual increase in the rate of chronic hypertension (AAPC 4.1%, 95% CI 3.3% to 4.9%). (B) Trends in eclampsia in the U.S. from 1989 to 2020 among singleton deliveries. The figure demonstrates the rate of eclampsia over time. There was a significant 2.5% annual decline in the rate of eclampsia (AAPC −2.5%, 95% CI −4.0% to −1.0%). (C) Average annual percentage change (AAPC) and 95% confidence interval for hypertensive disorders of pregnancy, chronic hypertension, and eclampsia from 1989 to 2020 among singleton deliveries.
See this image and copyright information in PMC

References

    1. Hirshberg A, Srinivas SK. Epidemiology of maternal morbidity and mortality. Semin Perinatol 2017;41(6):332–337. doi: 10.1053/j.semperi.2017.07.007 - DOI - PubMed
    1. Gestational Hypertension and Preeclampsia. ACOG Practice Bulletin No. 202. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133(1):1. doi: 10.1097/aog.0000000000003018 - DOI
    1. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010;376(9741):631–44. doi: 10.1016/s0140-6736(10)60279-6 - DOI - PubMed
    1. Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980–2010: age-period-cohort analysis. BMJ 2013;347:f6564. doi: 10.1136/bmj.f6564 - DOI - PMC - PubMed
    1. Wallis AB, Saftlas AF, Hsia J, Atrash HK. Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987–2004. Am J Hypertens 2008;21(5):521–6. doi: 10.1038/ajh.2008.20 - DOI - PubMed