The prevalence of hypertensive disorders of pregnancy and associated risk factors has increased between 2010 and 2021 among pregnant individuals in the United States, according to a recent study published in JAMA.1
Takeaways
- Hypertensive disorders of pregnancy increased from 4.4% in 2010 to 9.4% in 2021 among pregnant individuals in the United States.
- Chronic hypertension and gestational diabetes saw notable increases, rising from 1.2% to 2.7% and 0.7% to 1.1%, respectively, over the study period.
- Moderate risk factors such as obesity and advanced maternal age also increased, with obesity rising from 22.5% to 30.5% and maternal age from 14.7% to 20.1%.
- The use of in vitro fertilization (IVF) and longer interpregnancy intervals both showed increases, with IVF rising from 0.5% to 1.5% and interpregnancy intervals from 5.6% to 6.3%.
- The study underscores the importance of addressing modifiable risk factors through public health initiatives to reduce the incidence of preeclampsia and other hypertensive disorders during pregnancy.
Preeclampsia presents as high blood pressure during pregnancy, usually occurring in the second half of pregnancy, during labor, or shortly following delivery.2 Symptoms include changes in vision, headaches, leg swelling, and abdominal pain. However, these symptoms may occur in healthy pregnancies, and some women with preeclampsia may have no symptoms.
Blood pressure measurements during prenatal visits are utilized for preeclampsia screening. The US Preventive Services Task Force recommends screening even in women without a history of preeclampsia or high blood pressure, as screening has few adverse outcomes and treatment can lead to major health benefits.
Associations have been identified between preeclampsia and severe maternal and neonatal morbidity and mortality.1 Chronic hypertension, preeclampsia history, pregestational diabetes, autoimmune disease, multifetal gestation, and kidney disease are all high-risk factors of preeclampsia.
Moderate risk factors include advanced maternal age, nulliparity, interpregnancy interval of 10 or more years, body mass index (BMI) of at least 30, family preeclampsia history, in vitro fertilization (IVF), Black race, and low socioeconomic status. While preeclampsia trends were evaluated using data from 1988 to 2014, updated data is needed.
Investigators conducted a population-based retrospective study to evaluate preeclampsia trends from 2010 to 2021. Nonanomalous live births at 24 to 42 weeks’ gestation in the United States between January 2010 and December 2021 were included in the analysis.
Participants presented to prenatal care prior to 16 weeks’ gestation. Those without a complete birth certificate were excluded. The National Vital Statistics System database was consulted for birth certificate data.
Risk factors recorded in the database included high risk criteria for chronic hypertension, multifetal gestation, and pregestational diabetes, as well as moderate risk criteria for BMI of 30 or higher, nulliparity, IVF, advanced maternal age, and interpregnancy interval of 10 or more years. Trends for each risk factor and for hypertensive disorders of pregnancy were evaluated.
There were 46,526,529 US births from 2010 to 2021 recorded, 32,752,948 of which were included in the final analysis. The rate of chronic hypertension increased by 1.5% between 2010 and 2021, from 1.2% to 2.7%. An increase was also seen for the rate of gestational diabetes of 0.4%, from 0.7% to 1.1%.
A decrease in the rate of multifetal gestation of -0.5% was reported, from 1.7% in 2010 to 1.2% in 2021. For moderate risk factors, the rate of obesity increased by 8% between 2010 and 2021, from 22.5% to 30.5%.
Additional increases during this time include advanced maternal age from 14.7% to 20.1%, IVF from 0.5% to 1.5%, and interpregnancy interval from 5.6% to 6.3% These increases were 5.4%, 1%, and 0.7%, respectively.
Finally, a decrease of -2.8% was observed for nulliparity, from 42.8% to 40%. Overall, hypertensive disorders of pregnancy underwent a 5% increase, from 4.4% in 2010 to 9.4% in 2021.
These results indicated increases in hypertensive disorders of pregnancy and most associated risk factors between 2010 and 2021. Investigators recommended public health factors to reduce modifiable risk factors of preeclampsia be emphasized.
Reference
- Ayyash MK, McLaren R, Shaman M, Al-Kouatly HB. Trends in preeclampsia risk factors in the US from 2010 to 2021. JAMA. 2024. doi:10.1001/jama.2024.8931
- Jin J. Screening for Preeclampsia During Pregnancy. JAMA. 2017;317(16):1700. doi:10.1001/jama.2017.3988
