Factors Associated with the Severity of the Hypertensive Disorders of Pregnancy: A Cross-Sectional Study

Abstract

Background:

Hypertensive disorders of pregnancy (HDP) are a spectrum of disorders with increasing severity: gestational hypertension, preeclampsia, preexisting hypertension with preeclampsia, and severe preeclampsia/eclampsia. Factors associated with developing more severe HDP have not been established.

Methods:

We conducted a retrospective, cross-sectional study using electronic health records of women diagnosed with HDP who delivered between 2014 and 2017 at two large academic medical centers. Factors associated with HDP severity were evaluated using adjusted ordinal logistic regression models to estimate odds ratios.

Results:

Among 4,429 women diagnosed with an HDP, 2,330 (53%) had gestational hypertension, 902 (20%) had preeclampsia, and 1,197 (27%) had severe preeclampsia/eclampsia. Eighty-three percent never progressed to a more severe HDP past their original diagnosis. The median (quartile 1, quartile 3) maternal age at delivery was 29 (24, 33) years, and the median onset of HDP was 37 (35, 39) weeks. Forty-nine percent were White, 30% were Black, and 20% were “other” race; and 16% were Hispanic/Latina. Factors independently associated with more severe HDPs included earlier gestational age of HDP onset, Hispanic/Latina ethnicity, black or other versus white race, nulliparous delivery, and gestational diabetes mellitus. Factors independently associated with less severe HDPs were commercial or other (including self-pay) versus government payor and higher maternal body mass index.

Conclusions:

In a large, diverse cohort, several factors were associated with more severe forms of HDP. Further study is needed to assess whether women at higher risk for developing more severe HDP may benefit from closer monitoring to improve maternal-fetal outcomes.