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

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.

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.