Association of Birth Year of Pregnant Individuals With Trends in Hypertensive Disorders of Pregnancy in the United States, 1995-2019

Cameron, Natalie A; Petito, Lucia; Shah, Nilay S.; Perak, Amanda M.; Catov, Janet M.; Bello, Natalie A.; Capewell, Simon; O’Flaherty, Martı́n; Lloyd-Jones, Donald M; Greenland, Philip; Grobman, William A.; Khan, Sadiya S.

doi:10.1001/jamanetworkopen.2022.28093

Cited by 15 publications

(6 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall, results regarding sex differences were similar among White and Black pregnancies, despite the rates of hypertensive disorders of pregnancy, SGA and preterm birth differing between these groups [ 56 – 58 ]. Among surviving infants, the impact of PAH on birthweight varies throughout gestation; early in gestation, males reduce their birthweight more, while this reverses around late pre-term so that females are more affected, with males again being more affected at term.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in growth and mortality in pregnancy-associated hypertension

Hercus,

Metcalfe,

Christians

2024

PLoS ONE

View full text Add to dashboard Cite

Background It is hypothesized that male fetuses prioritize growth, resulting in increased mortality, whereas females reduce growth in the presence of adversity. Preeclampsia reflects a chronic condition, in which fetuses have the opportunity to adjust growth. If females reduce their growth in response to preeclampsia, but males attempt to maintain growth at the cost of survival, we predict that differences in birthweight between preeclamptic and non-preeclamptic pregnancies will be greater among females, whereas differences in mortality will be greater among males. Methods We analysed data from the Centers for Disease Control and Prevention. We compared pregnancies with pregnancy-associated hypertension (PAH) and controls. Results The difference in birthweight between pregnancies affected by PAH and controls varied by fetal sex and gestational age. Among pregnancies of White individuals, at 34–35 weeks, the difference between PAH and controls was higher among females, as predicted. However, this pattern was reversed earlier in pregnancy and around term. Such variation was not significant in Black pregnancies. In both Black and White pregnancies, early in gestation, males had lower odds of death in PAH pregnancies, but higher odds of death in control pregnancies, counter to our prediction. Later, males had higher odds of death in PAH and controls, although the increased odds of death in males was not higher in PAH pregnancies than in controls. Overall, the difference in birthweight between surviving and non-surviving infants was greater in males than in females, opposite to our prediction. Conclusions The impact of PAH on birthweight and survival varies widely throughout gestation. Differences in birthweight and survival between male and female PAH and controls are generally not consistent with the hypothesis that males prioritize fetal growth more than females, and that this is a cause of increased mortality in males.

show abstract

Section: Discussionmentioning

confidence: 99%

Sex differences in growth and mortality in pregnancy-associated hypertension

Hercus,

Metcalfe,

Christians

2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…In a recent analysis that examined age-period-cohort effects, incidence of HDP was over 2-times higher among birthing individuals belonging to the most recent generations (maternal birth years 1990s-2000s) compared with birthing individuals born in the 1950s, even after accounting for maternal age at first birth. 58 There is substantial evidence to support an association between new-onset HDPs and atherosclerotic CVD risk. 59 In an observational cohort study of 54 588 individuals in the Nurses' Health Study, risk of incident hypertension after delivery was greater among those with gestational hypertension or preeclampsia compared with those without hypertension during pregnancy.…”

Section: Hdps: Gestational Hypertension and Preeclampsiamentioning

confidence: 99%

Section: Apos Cvd Risk Factors and Cvd Riskmentioning

confidence: 99%

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

Khan

Cameron

Lindley

2023

Circulation Research

Self Cite

View full text Add to dashboard Cite

Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.

show abstract

“…Globally, preeclampsia accounts for 2-8% of all pregnancy complications, resulting in over 50,00 maternal deaths and 500,000 fetal deaths [1]. In the United States, rates of preeclampsia have steadily been on the rise, with the burden of the disease disproportionately affecting Black and Indigenous pregnant patients [2]. Given this reality, it is imperative to scrutinize the causative factors of preeclampsia and potential comorbidities that heighten the risk of further complications or mortality to improve patient care, screenings, and outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia

Elkattawy,

Patel,

Montoya

et al. 2024

Cureus

View full text Add to dashboard Cite

Introduction: The purpose of this study was to determine the prevalence of congestive heart failure (CHF) among patients admitted with preeclampsia as well as to analyze the independent association of CHF with in-hospital outcomes among women with preeclampsia. Methods: Data were obtained from the National (Nationwide) Inpatient Sample (NIS) from January 2016 to December 2019. We assessed the independent association of CHF with outcomes in patients admitted with preeclampsia. Predictors of mortality in patients admitted with preeclampsia were also analyzed. Results: Women with preeclampsia in the United States between 2016 and 2019 were included in our analysis. A total of 256,010 cases were isolated, comprising 1150 patients with preeclampsia and CHF (0.45%). Multivariate analysis demonstrated that CHF in patients with preeclampsia was independently associated with several outcomes, among them cardiac arrest (adjusted OR (aOR) 4.635, p=0.004), ventricular tachycardia (aOR 17.487, p<0.001), pulmonary embolism (aOR 6.987, p<0.001), and eclampsia (aOR 2.503, p=0.011). Conversely, we found CHF to be protective against postpartum hemorrhage (aOR 0.665, p=0.003). Among the predictors of mortality in preeclampsia are age (aOR 1.062, p=0.022), Asian or Pacific Islander race (aOR 4.695, p=0.001), and CHF (aOR 25.457, p<0.001). Conclusions: In a large cohort of patients admitted with preeclampsia, we found the prevalence of CHF to be 0.45%. CHF was associated with several adverse outcomes as well as increased length of stay.

show abstract

Association of Birth Year of Pregnant Individuals With Trends in Hypertensive Disorders of Pregnancy in the United States, 1995-2019

Cited by 15 publications

References 34 publications

Sex differences in growth and mortality in pregnancy-associated hypertension

Sex differences in growth and mortality in pregnancy-associated hypertension

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia

Contact Info

Product

Resources

About