Introduction:
Pregestational hypertension is associated with poor fetal and maternal outcomes, however, the impact on maternal cardiovascular outcomes is not well defined. In this study, we aim to study the impact of pregestational hypertension on maternal cardiovascular outcomes.
Methods:
Pregnant women hospitalized from January 2016 to December 2017 were identified in the Nationwide Inpatient Sample. Pregnant females with pregestational hypertension were identified using AHRQ comorbidity measures. Outcomes of interest were mortality, myocardial infarction (MI), and stroke. Multivariate regression analysis adjusting for differences in baseline comorbidities was used for odds ratio (OR) and 95% confidence interval (CI).
Results:
Among 8,141,277 pregnant women, 224,295 (2.76%) had pregestational hypertension. Pregnant females with pregestational hypertension were significantly older (mean age of 31.52 +/- 6.03 vs. 28.65 +/- 5.84, p-value<0.001), and had a higher burden of comorbidities includingpregestational diabetes mellitus (10.4% vs. 1.1%, p-value<0.001), gestational diabetes (26.3% vs. 8.1%, p-value<0.001), obesity (27.6% vs. 7.7%, p-value<0.001), smoking (16.4% vs. 9.8%,p-value<0.001), hyperlipidemia (2.1% vs. 0.2%, p-value<0.001), and depression; 6.6% vs. 3.0%, p-value<0.001. Females with pregestational hypertension had more cesarean section; 46.6% vs. 29.2%, p-value<0.001, intra-uterine death; 1.3% vs. 0.4%, p-value<0.001, and spontaneous abortion; 0.6% vs. 0.3%, p-value<0.001. Pregetational hypertension had higher mortality rate (55.7 vs. 10.1 per 100,000 hospitalizations, p-value<0.001), MI rate (207.3 vs. 9.3 per 100,000 hospitalizations, p-value<0.001), and stroke rate (288.4 vs. 22.6 per 100,000 hospitalizations, p-value<0.001). Pregestational hypertension was associated with significantly worse outcomes including in-hospital mortality (aOR 3.01, 95% CI 2.48-3.67), MI (aOR 8.27, 95% CI 7.30-9.35), and stroke (aOR 9.31, 95% CI 8.47-10.24).
Conclusions:
Pregestational hypertension is associated with poor maternal cardiovascular outcomes in pregnancy. Further efforts should be directed to identifying high-risk females and better approaches to management are warranted.
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