Top 5 Takeaways

1. Increasing Prevalence of HDPs: The prevalence of hypertensive disorders in pregnancy (HDP) increased from 13.3% in 2017 to 15.9% in 2019 among delivery hospitalizations.
2. Age and Racial Disparities: HDP prevalence was highest among women aged 35–44 years (18.0%) and 45–55 years (31.0%), and among Black women (20.9%) and American Indian and Alaska Native women (16.4%).
3. Maternal Mortality Association: Among maternal deaths during delivery hospitalization, 31.6% had a diagnosis code for HDP documented.
4. Preventability of HDP Complications: Severe HDP-associated complications and mortality are preventable with timely recognition, treatment, and awareness of urgent maternal warning signs.
5. Socioeconomic and Regional Differences: HDP prevalence was higher among women residing in rural areas, low-income zip codes, and in hospitals in the South and Midwest regions of the United States.

Original Article Author and Citation

Corresponding Author

Nicole D. Ford, nford@cdc.gov

Suggested Citation

Ford ND, Cox S, Ko JY, et al. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization — United States, 2017–2019. MMWR Morb Mortal Wkly Rep 2022;71:585–591. DOI: http://dx.doi.org/10.15585/mmwr.mm7117a1.

Summary

During 2017–2019, the prevalence of hypertensive disorders in pregnancy (HDP) increased from 13.3% to 15.9% among delivery hospitalizations in the United States. This increase was driven primarily by a rise in pregnancy-associated hypertension. HDPs were more prevalent among older women, Black women, American Indian and Alaska Native women, and those living in rural or low-income areas. HDP was documented in 31.6% of maternal deaths during delivery hospitalization, highlighting the critical need for prompt diagnosis and treatment.

Methods

The CDC analyzed data from the National Inpatient Sample, a nationally representative sample of U.S. hospital discharges, to calculate the annual prevalence of HDP among delivery hospitalizations. HDPs were identified using ICD-10-CM diagnosis codes for chronic and pregnancy-associated hypertension. The analysis included the calculation of weighted annual prevalence and 95% confidence intervals, as well as assessments of differences in HDP prevalence by maternal characteristics and geographic factors.

Discussion

The study found significant increases in HDP prevalence, with notable disparities based on age, race, ethnicity, socioeconomic status, and geographic location. Black women and those living in the South and Midwest had higher rates of HDP, contributing to increased risk of severe maternal complications and mortality. Addressing these disparities requires targeted public health interventions and quality improvement initiatives to ensure equitable access to care and prompt treatment of HDP.

Conclusion

The increasing prevalence of HDP and its association with severe maternal complications and mortality underscore the need for comprehensive strategies to prevent, identify, and treat HDP. These strategies should include continuous and coordinated care, awareness of maternal warning signs, and efforts to address social determinants of health and healthcare disparities.

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