Hypertensive Disorders of Pregnancy, Cesarean Delivery, and Severe Maternal Morbidity in an Urban Safety-Net Population

Abstract

<jats:title>Abstract</jats:title> <jats:p>Hypertensive disorders of pregnancy (HDP) are a leading cause of severe maternal morbidity (SMM), yet mediation by cesarean delivery is largely unexplored. We investigated the association between HDP and SMM in a cohort of deliveries at a safety net institution in Atlanta, Georgia during 2016-2018. Using multivariable generalized linear models, we estimated adjusted risk differences (aRDs), adjusted risk ratios (aRRs), and 95% confidence intervals (CIs) for the association between HDP and SMM. We examined interactions with cesarean delivery and used mediation analysis with four-way decomposition to estimate excess relative risks. Among 3,723 deliveries, the SMM rate for women with and without HDP was 124.4 per 1,000 and 52.0 per 1,000, respectively. The aRR for the total effect of HDP on SMM was 2.55 (95% CI: 2.15-3.39). About 55.2% (95% CI: 25.7-68.5) of excess relative risk was due to neither interaction nor mediation, 24.9% (95% CI: 15.4-50.0) was due to interaction between HDP and cesarean delivery, 9.6% (95% CI: 3.4-15.2) was due to mediation, and 10.3% (95% CI: 5.4-20.3) was due to mediation and interaction. HDP are a potentially modifiable risk factor for SMM; implementing evidence-based interventions for the prevention and treatment of HDP is critical for reducing SMM risk.</jats:p>

Frequency of cesarean section in pregnant women with risk factors for preeclampsia: prospective cohort study

“…In pregnant women with high-risk pregnancies, such as those with preeclampsia, delivery is usually induced prematurely and ends instrumentally or surgically in the interest of the mother and/or fetus [2]. The higher frequency of CS in the experimental group in our study is not accidental.…”

“…Preeclampsia was associated with an increased risk for severe maternal morbidity and the risk was consistently greater for women with CS relative to those delivering vaginally [2].…”

“…Preeclampsia is a disorder of pregnancy associated with new-onset hypertension after the 20th week of gestation (WG). As reported The American College of Obstetricians and Gynecologists hypertension and other signs or symptoms of preeclampsia may present in some women in the absence of proteinuria, although often accompanied by new-onset proteinuria [1].The preeclampsia rate in the United States is 6-8% of all pregnancies [2].…”

“…Several studies have shown a higher probability of cesarean section (CS) in pregnant women with hypertension, preeclampsia, gestational diabetes, and infant birth weight over 4000 g [2,5,6]. Yücesoy et al [7] also describe a higher frequency of CS in pregnant women with preeclampsia.…”

Predicting hypertensive disorders in pregnancy using multiple methods: Models with the placental growth factor parameter

“…Hypertensive disorders in pregnancy (HDP) is an important risk factor for increasing neonatal and maternal morbidity and mortality [ 1 , 2 , 3 ]. Early prediction and treatment can be carried out through related risk factors [ 4 ].…”