Obstetric outcomes among women with chronic hypertension by hospital location, teaching status, and volume

Abstract Background Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. Methods Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. Results A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. Conclusions Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.

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Optimizing the control group for evaluating ART outcomes: can outpatient claims data yield a better control group?

Journal of Assisted Reproduction and Genetics ◽

10.1007/s10815-021-02111-6 ◽

2021 ◽

Cited By ~ 1

Author(s):

Judy E. Stern ◽

Chia-Ling Liu ◽

Xiaohui Cui ◽

Daksha Gopal ◽

Howard J. Cabral ◽

...

Keyword(s):

Claims Data ◽

Comparison Group ◽

Birth Certificate ◽

Treated Group ◽

Fertility Treatment ◽

Obstetric Outcomes ◽

Control Group ◽

Chronic Hypertension ◽

Adjusted Relative Risk ◽

Insurance Claims Data

Abstract Purpose We previously developed a subfertile comparison group with which to compare outcomes of assisted reproductive technology (ART) treatment. In this study, we evaluated whether insurance claims data in the Massachusetts All Payers Claims Database (APCD) defined a more appropriate comparison group. Methods We used Massachusetts vital records of women who delivered between 2013 and 2017 on whom APCD data were available. ART deliveries were those linked to a national ART database. Deliveries were subfertile if fertility treatment was marked on the birth certificate, had prior hospitalization with ICD code for infertility, or prior fertility treatment. An infertile group included women with an APCD outpatient or inpatient ICD 9/10 infertility code prior to delivery. Fertile deliveries were none of the above. Demographics, health risks, and obstetric outcomes were compared among groups. Multivariable generalized estimating equations were used to calculate adjusted relative risk (aRR) and 95% confidence intervals (CI). Results There were 70,726 fertile, 4,763 subfertile, 11,970 infertile, and 7,689 ART-treated deliveries. Only 3,297 deliveries were identified as both subfertile and infertile. Both subfertile and infertile were older, and had more education, chronic hypertension, and diabetes than the fertile group and less than the ART-treated group. Prematurity (aRR = 1.15–1.17) and birthweight (aRR = 1.10–1.21) were increased in all groups compared with the fertile group. Conclusion Although the APCD allowed identification of more women than the previously defined subfertile categorization and allowed us to remove previously unidentified infertile women from the fertile group, it is not clear that it offered a clinically significantly improved comparison group.

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Obstetric outcomes among women with gestational diabetes by hospital location, teaching status, and volume

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.471 ◽

2022 ◽

Vol 226 (1) ◽

pp. S277

Author(s):

Yue Song ◽

Katherine Fitch ◽

Brooke F. Mischkot ◽

Bharti Garg ◽

Alyssa R. Hersh ◽

...

Keyword(s):

Gestational Diabetes ◽

Obstetric Outcomes ◽

Teaching Status

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Impact of COVID-19 infection on obstetric outcomes in pregnant patients with chronic hypertension

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.290 ◽

2022 ◽

Vol 226 (1) ◽

pp. S165-S166

Author(s):

Rachel C. Schell ◽

Devin A. Macias ◽

W. Holt Garner ◽

Alesha M. White ◽

Donald D. McIntire ◽

...

Keyword(s):

Obstetric Outcomes ◽

Chronic Hypertension

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Hypertensive disorders of pregnancy and impact on in-hospital cardio-obstetric outcomes

European Heart Journal ◽

10.1093/ehjci/ehaa946.3306 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Wu ◽

C Chew-Graham ◽

A Maas ◽

L Chappell ◽

J Potts ◽

...

Keyword(s):

Myocardial Infarction ◽

The United States ◽

Peripartum Cardiomyopathy ◽

Assessment Model ◽

Obstetric Outcomes ◽

Chronic Hypertension ◽

Funding Source ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Comorbidity Burden

Abstract Introduction Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity. However, short-term outcomes of HDP subgroups remain unknown. Methods 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. Results 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. Conclusion 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. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): NIHR

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Researchers discuss evidence on managing mild chronic hypertension during pregnancy

PsycEXTRA Dataset ◽

10.1037/e556762006-008 ◽

2001 ◽

Keyword(s):

Chronic Hypertension

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Loss of distensibility in cerebral arteries with chronic hypertension and vasospasm after subarachnoid hemorrhage

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9591524.0557 ◽

2005 ◽

Vol 25 (1_suppl) ◽

pp. S557-S557

Author(s):

Takeshi Kondoh ◽

Seiji Nakajima ◽

Akitsugu Morishita ◽

Haruo Yamashita ◽

Eiji Kohmura ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Arteries ◽

Chronic Hypertension

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Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

The Journal of Knee Surgery ◽

10.1055/s-0040-1701516 ◽

2020 ◽

Author(s):

Robert Brochin ◽

Jashvant Poeran ◽

Khushdeep S. Vig ◽

Aakash Keswani ◽

Nicole Zubizarreta ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Trend Test ◽

Strong Impact ◽

Hospitalization Costs ◽

Teaching Status ◽

Increasing Trend ◽

Total Knee ◽

Increasing Trends

AbstractGiven increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

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199-LB: Low Prevalence of Small-for-Gestational-Age in Women with Type 1 Diabetes and Chronic Hypertension

Diabetes ◽

10.2337/db19-199-lb ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 199-LB

Author(s):

SARIT HELMAN ◽

TAMARRA JAMES-TODD ◽

FLORENCE M. BROWN

Keyword(s):

Type 1 Diabetes ◽

Gestational Age ◽

Small For Gestational Age ◽

Chronic Hypertension ◽

Low Prevalence

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