Hypertensive disorders of pregnancy and impact on in-hospital cardio-obstetric outcomes
Session title: Cardiovascular Disease in Women
Topic: Pregnancy and Cardiovascular Disease
Session type: Rapid Fire Abstracts
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P Wu1 , C Chew-Graham1 , A Maas2 , L Chappell3 , J Potts1 , M Gulati4 , K Jordan1 , M Mamas1 , 1Keele University, School of Primary, Social and Community Care - Stoke-on-Trent - United Kingdom of Great Britain & Northern Ireland , 2University Medical Center St Radboud (UMCN) - Nijmegen - Netherlands (The) , 3University College London - London - United Kingdom of Great Britain & Northern Ireland , 4University of Arizona - Phoenix - United States of America ,


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Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity. However, short-term outcomes of HDP subgroups remain unknown.

Using the United States National Inpatient Sample database, all delivery hospitalizations between 2004 and 2014 with or without HDP (preeclampsia/eclampsia, chronic hypertension, superimposed preeclampsia on chronic hypertension and gestational hypertension) were analysed to examine the association between HDP and adverse in-hospital outcomes.

We identified >44 million delivery hospitalizations, within which the prevalence of HDP increased from 8% to 11% over a decade with increasing comorbidity burden. Women with chronic hypertension have higher risks of myocardial infarction, peripartum cardiomyopathy, arrhythmia and stillbirth compared to women with preeclampsia. Out of all HDP subgroups, the superimposed preeclampsia population had the highest risk of stroke (OR 7.83, 95% CI 6.25, 9.80), myocardial infarction (OR 5.20, 95% CI 3.11, 8.69), peripartum cardiomyopathy (OR 4.37, 95% CI 3.64, 5.26), preterm birth (OR 4.65, 95% CI 4.48, 4.83), placental abruption (OR 2.22, 95% CI 2.09, 2.36), and stillbirth (OR 1.78, 95% CI 1.66, 1.92) compared to women without HDP. In conclusion, we are the first to evaluate chronic SH without superimposed preeclampsia as a distinct subgroup in HDP and show that women with chronic SH are at even higher risk of some adverse outcomes compared to women with preeclampsia.

The chronic hypertension population, with and without superimposed preeclampsia, is a particularly high risk group and may benefit from increased antenatal surveillance and the use of a prognostic risk assessment model incorporating HDP to stratify intrapartum care.