Abstract P247: Factors Associated With the Severity of the Hypertensive Disorders of Pregnancy

Objective: Hypertensive disorders of pregnancy (HDP) are a spectrum of disorders with increasing severity: gestational hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension, and severe preeclampsia/eclampsia. Although factors associated with developing an HDP have been established, it is unclear which factors are associated with more severe HDP. This study aimed to estimate the associations between clinical, demographic, and social factors and severity of HDP. Methods: We conducted a retrospective, cross-sectional study of electronic medical records of women who delivered between 2014 and 2017 at two academic medical centers and were diagnosed with an HDP during pregnancy or up to 6 weeks postpartum. Patients were categorized by highest severity of HDP. We used ordinal logistic regression models to estimate odds ratios (ORs) for the severity of HDP by covariates including demographic data and clinical characteristics. Results: Among 5,607 women diagnosed with an HDP, 2,609 (47%) had gestational hypertension, 1,748 (31%) had preeclampsia, 608 (11%) had preeclampsia superimposed on chronic hypertension, and 642 (11%) had severe preeclampsia/eclampsia. Median (Q1, Q3) maternal age was 30 (25, 34) years; 46% (2,588 of 5,607) were white race, 32% (1,811 of 5,607) were black race, and 22% were other race (1,208 of 5,607); 15% (822 of 5,607) were Hispanic/Latina; 13% (735 of 5,607) had gestational diabetes; 42% (2,351 of 5,607) received care at institution A, 44% (2,445 of 5,607) at institution B, and 14% (811 of 5,607) at both; median (Q1, Q3) maternal body mass index near delivery was 35(30, 41) kg/m^2; and median (Q1, Q3) household income of ZIP code of residence was $50,734 ($43,592, $69,380). Factors independently associated with more severe HDP (OR, 95% CI) included: older maternal age (1.15 per 10-year increase, 1.05 - 1.27), Black race (1.48, 1.3 - 1.68) versus white, Hispanic/Latina ethnicity (1.51, 1.22 - 1.88), gestational diabetes (1.35, 1.16 - 1.65), and receiving care at institution A vs B (1.23, 1.1 - 1.38) or both institutions vs institution B (1.32, 1.13 - 1.54). Maternal body mass index near delivery (0.98 per 10 kg/m^2 increase, 0.92 - 1.05) was not meaningfully associated with more severe HDP. Conclusions: Several factors were associated with more severe HDP. Importantly, these factors may help identify women who are at a higher risk for developing a more severe form of HDP. Further study is needed to confirm these findings and determine interventions that can mitigate risk to improve women’s cardiovascular health.