Abstract 4145375: Examining Maternal and Fetal Outcomes Across Various Subtypes of Hypertension During Pregnancy

Introduction: Hypertension disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality worldwide. It can be categorized as chronic hypertension (CH), gestational hypertension (GHTN), preeclampsia (PRE), and chronic hypertension with superimposed preeclampsia (SPE).We aim to assess in-hospital maternal and fetal outcomes of women in each of these groups in comparison to normotensive controls. Methods: Study sample included women in the National Inpatient Sample dataset from 2016 to 2020 who were categorized into the 4 groups of HDP described above. They were compared to normotensive pregnancies for maternal and fetal outcomes using regression analysis after adjusting for age, race, C-section status, and comorbidities. Results: The study dataset from October 2015- December 2020 included 19,089,780 labor admissions with 2,771,809 patients affected by HDP. The HDP groups were distributed as follows: GHTN - 38%, PRE - 32%, SPE - 11%, and CHTN - 19%. Women with PRE, SPE, and CH had significantly higher rates of mortality, circulatory shock, peripartum cardiomyopathy, acute kidney injury, preterm labor, stillbirth, and cerebrovascular events compared to normotensive patients, while GHTN did not. Specifically, maternal mortality was highest in the SPE group (adjusted odds ratio [aOR] 3.16), followed by PRE (aOR 2.91) and CH (aOR 2.42). Additionally, all HDP groups had higher rates of small for gestational age and significant bleeding compared to normotensive patients. Conclusions: Pregnant patients with CH, PRE, and SPE experience various higher rates of adverse maternal and fetal outcomes when compared to normotensive patients. Future studies should examine the effect of early high-risk group identification on adverse outcomes in hypertension management.