Maternal Hypertensive Disorders in Pregnancy and Maternal Morbidity at Delivery and Postpartum

women"s health;maternal health;pregnancy complications;hypertension;pre-eclampsia;postpartum period;hospitalization;Epidemiology

Harvey, Elizabeth MarilynVisvanathan, Kala ;

Johns Hopkins University

关键词: women";    s health;    maternal health;    pregnancy complications;    hypertension;    pre-eclampsia;    postpartum period;    hospitalization;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/59318/HARVEY-DISSERTATION-2017.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background: Rates of hypertensive disorders and other chronic conditions in pregnancy are increasing among childbearing women in the United States. This study examined the relation of maternal hypertensive disorders and other chronic and pregnancy-associated conditions with severe maternal morbidity (SMM) at delivery and postpartum rehospitalization.Methods: Birth certificates and fetal death records (BCFD) were linked to delivery-related hospital discharge (HDD) records in Massachusetts from 2000-2012, using the Pregnancy to Early Life Longitudinal (PELL) data system (n=960,982). Non-injury emergency department (ED), observational stay (OS) and non-delivery hospital discharge (HD) records in the first year postpartum also were linked to corresponding BCFD and HDD deliveries from 2002-2011 (n=735,576); a subset of deliveries to women without chronic medical conditions were also examined (n=685,228). Multivariate logistic regression models estimated the odds of SMM at delivery, multivariate log-binomial and Poisson models estimated the risk of rehospitalization within six weeks and one year postpartum; analyses used a generalized estimating equations approach to account for correlation due to repeat births of women and adjusted for social and biological characteristics. Analyses also examined whether SMM modified the relation between hypertensive disorders and rehospitalization.Results: Between 2000-2012, maternal hypertensive disorders were documented in 8.7% of deliveries and the SMM rate was 101.9 per 10,000 deliveries; 5.2% of deliveries from 2002-2011 had at least one rehospitalization within six weeks and 19.9% within one year postpartum. Hypertensive disorders and other chronic conditions increased the odds of SMM and the risk of rehospitalization up to one year postpartum; this risk varied by type of hypertensive disorder. SMM at delivery independently increased rehospitalization risk in the first six weeks and year postpartum and slightly moderated the relation between hypertensive disorders and rehospitalization.Conclusions: Maternal hypertensive disorders and other chronic conditions were associated with adverse maternal health outcomes at and after delivery and SMM at delivery was associated with increased risk of rehospitalization within one year postpartum. Our study highlights the need to prevent and manage hypertensive disorders and other chronic and pregnancy-associated conditions before, during, and after pregnancy as well as the need to address preventable SMM and mitigate its impacts after delivery.