Descriptive Epidemiology of Chronic Hypertension, Gestational Hypertension, and Preeclampsia in New York State, 1995–2004

Abstract

We examined social, demographic, and behavioral predictors of specific forms of hypertensive disorders in pregnancy in New York State. Administrative data on 2.3 million births over the period 1995–2004 were available for New York State, USA, with linkage to birth certificate data for New York City (964,071 births). ICD-9 hospital discharge diagnosis codes were used to assign hypertensive disorders hierarchically as chronic hypertension, chronic hypertension with superimposed preeclampsia, preeclampsia (eclampsia/severe or mild), or gestational hypertension. Sociodemographic and behavioral predictors of these outcomes were examined separately for upstate New York and New York City by calculating adjusted odds ratios. The most commonly diagnosed conditions were preeclampsia (2.57 % of upstate New York births, 3.68 % of New York City births) and gestational hypertension (2.46 % of upstate births, 1.42 % of New York City births). Chronic hypertension was much rarer. Relative to non-Hispanic Whites, Hispanics in New York City and Black women in all regions had markedly increased risks for all hypertensive disorders, whereas Asian women were at consistently decreased risk. Pregnancy-associated conditions decreased markedly with parity and modestly among smokers. A strong positive association was found between pre-pregnancy weight and risk of hypertensive disorders, with slightly weaker associations among Blacks and stronger associations among Asians. While patterns of chronic and pregnancy-induced hypertensive disorders differed, the predictors of gestational hypertension and both mild and severe preeclampsia were similar to one another. The increased risk for Black and some Hispanic women warrants clinical consideration, and the markedly increased risk with greater pre-pregnancy weight suggests an opportunity for primary prevention among all ethnic groups.

Persistent organochlorines and hypertensive disorders of pregnancy

“…The restriction to live birth outcomes may have excluded a significant number of women with severe preeclampsia, with unknown impact on the measures of association. The information on preexisting hypertension and diabetes from this time period may well be incomplete, but insofar as organochlorines are related to increased risk of hypertension, any biases would tend to shift effect estimates upward, The absolute frequency of gestational hypertension and preeclampsia were higher than is commonly observed, but not inconsistent with some other monitored pregnancy cohorts (Macdonald-Wallis et al , 2013) and with the high proportion of African-American women included in our sample (Savitz et al , 2013). The laboratory assays of organochlorines used current technology and are likely accurate measures of serum levels, despite the long period of sample storage.…”

Ambient Air Pollution and Risk of Gestational Hypertension

“…First, we stratified the analyses by parity and smoking, given the decrease in risk with higher parity and smoking (24). We also performed sensitivity analysis restricted to women who had complete data on prepregnancy body mass index (n = 137,732, 67%).…”

Birth Weight and Birth Weight for Gestational Age in Relation to Risk of Hospitalization with Primary Hypertension in Children and Young Adults

“…All those whose mother did not have chronic hypertension during her pregnancy were then classified according to whether or not their mother had preeclampsia or eclampsia during her pregnancy. Finally, all those whose mother did not have preeclampsia or eclampsia during her pregnancy were classified according to whether or not their mother had a diagnosis of gestational hypertension (modified from Savitz et al) (Savitz, Danilack, Engel, Elston, & Lipkind, 2014). …”