Pre-pregnancy hypertension on the rise throughout the US

Pre-pregnancy hypertension rates have climbed substantially in the United States in recent years, according to a new analysis published in the Journal of the American College of Cardiology.

“Cardiovascular disease (CVD) is now the leading cause of pregnancy-related deaths, and hypertension is a well-established risk factor for these potentially preventable deaths,” wrote lead author Natalie A. Cameron, MD, Northwestern University Feinberg School of Medicine in Chicago, and colleagues. “Hypertension in women prior to pregnancy is associated with increased risks of pre-eclampsia/eclampsia, renal failure, and CVD postpartum, as well as offspring complications in the perinatal period and across the life course.”

Cameron et al. explored data from nearly 48 million births from 2007 to 2018. All mothers were between the ages of 15 and 44 years old. Data was taken from the CDC Natality Database and included births from throughout the United States.

Overall, the authors found, the rate of pre-pregnancy hypertension increased across the board. Among rural women, the rate increased from 13.7 per 1,000 live births to 23.7. Among urban women, the rate increased from 10.5 per 1,000 live births to 20. Obesity, poor diets and sedentary behavior were all listed as probably explanations for this shift.

The team did note that their work had certain limitations. For example, some race/ethnicity groups—including Asian and Pacific Islanders—were not represented especially well in the analysis. Also, there was a lack of data related to areas such as physical activity, diets, pre-pregnancy BMI and pre-pregnancy diabetes among the women included in the study.

Even with those limitations, however, the authors noted that their findings were able to “confirm and extend prior reports of increasing rates of hypertension among reproductive-aged and pregnant women over the past several decades.”

“Given these concerning trends in pre-pregnancy hypertension, future work is needed to quantify temporal changes in related maternal cardiovascular risk factors including obesity, diabetes, and dyslipidemia, and examine associations with trends in pre-pregnancy hypertension,” the authors concluded. “Additional research is also necessary to translate the impact of changes in pre-pregnancy hypertension on maternal and fetal morbidity and mortality. Finally, it is important to quantify maternal cardiovascular health disparities among women from other racial/ethnic backgrounds such as disaggregated Asian subgroups.”

The full study can be read here