Pregnancy outcomes in women with chronic hypertension: a population-based study.
OBJECTIVE
To determine the pregnancy outcomes associated with maternal chronic hypertension.


METHODS
Retrospective, population-based cohort study of maternal and infant discharge records linked to birth records in California from 1991 to 2001 were examined for demographics and pregnancy outcomes, and comparisons were made between those with and without chronic hypertension. One randomly selected pregnancy per subject was included.


RESULTS
The number of women who delivered with chronic hypertension (0.69% incidence) was 29,842. As compared to non-chronic hypertensive patients, fetal and neonatal mortality and in-hospital maternal mortality were increased (ORs and 95% CIs 2.3, (2.1, 2.6); 2.3, (2.0, 2.7); and 4.8, (3.1, 7.6) respectively). Major maternal morbidity was increased: stroke, OR 5.3, (3.7, 7.5); renal failure, OR 6.0, (4.4, 8.1); pulmonary edema, OR 5.2, (3.9, 6.7); severe preeclampsia, OR 2.7, (2.5, 2.9); and placental abruption OR 2.1, (2.0, 2.3). Neonatal morbidity was increased as well: fetal growth restriction, OR 4.9, (4.7, 5.2); prematurity, OR 3.2, (3.1, 3.3); low birth weight, OR 5.4, (5.2, 5.5); very low birth weight, OR 6.5, (6.2, 6.8); and respiratory distress syndrome, OR 4.0, (3.8, 4.2).


CONCLUSIONS
Pregnant women with chronic hypertension have significantly increased risks of maternal and perinatal morbidity and mortality. Women with this condition should be treated as high risk with appropriate maternal and fetal surveillance.
Gilbert
William M
WM
Department of Obstetrics and Gynecology, University of California, Davis, USA. gilberw@sutterhealth.org
Young
Ashley L
AL
Danielsen
Beate
B
D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality*; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D016017:Odds Ratio; D010298:Parity; D054238:Perinatal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality*; D011256:Pregnancy Outcome; D012189:Retrospective Studies