Health Services Research, Elevance Health, Indianapolis, IN, USA.
Enterprise Clinical Operations, Elevance Health, Indianapolis, IN, USA.
BMC Pregnancy Childbirth. 2023 Jul 14;23(1):514. doi: 10.1186/s12884-023-05818-9.
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.
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.
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.
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.
妊娠期高血压疾病的患病率持续上升，与母亲的多种不良结局和未来心血管风险相关。本研究评估了与妊娠期无高血压相比，妊娠期高血压疾病与母婴结局的关系。然后，我们评估了在妊娠期从较轻的高血压疾病向更严重的高血压疾病发展的相关危险因素。
我们利用全国保险公司的医疗补助索赔数据进行了倾向评分匹配的回顾性队列研究。研究人群包括 2016 年 7 月 1 日至 2018 年 12 月 31 日期间分娩的患有和不患有高血压疾病的母亲及其婴儿。高血压疾病包括妊娠期高血压、慢性高血压、子痫前期和子痫前期合并症。采用倾向评分匹配将不患有高血压疾病的母亲与患有高血压疾病的母亲相匹配。回归模型用于比较母婴结局。逐步逻辑回归用于确定与妊娠期高血压进展为子痫前期或慢性高血压进展为子痫前期合并症相关的特征。
我们观察到患有子痫前期或子痫前期合并症的母亲行剖宫产术（比值比 [OR]：1.61 和 1.99）和早产儿（OR：2.22 和 5.37）、呼吸窘迫综合征（OR：2.39 和 4.19）和低出生体重（OR：3.64 和 9.61）的风险最高，与无高血压的母亲相比，分别（所有结局的 p<0.05）。与无高血压相比，慢性或妊娠期高血压的这些结局略高，但大多数无统计学意义。严重高血压疾病的新生儿重症监护病房利用率较高（子痫前期的 OR：2.41，子痫前期合并症的 OR：4.87）。肥胖/超重和既往妊娠子痫前期史最有可能预测从妊娠期/慢性高血压进展为子痫前期/子痫前期合并症。
与无高血压的母亲相比，患有子痫前期或子痫前期合并症的母亲及其新生儿经历了更多的不良结局。患有妊娠期高血压的母亲及其新生儿的结局与无高血压的母亲相似。患有慢性高血压的母亲及其新生儿的结局在妊娠期高血压和子痫前期之间。肥胖/超重和既往妊娠子痫前期史是高血压进展的强烈危险因素。
