Clinical pathology selected abstracts

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Editor: Deborah Sesok-Pizzini, MD, MBA, chief medical officer, Labcorp Diagnostics, Burlington, NC, and adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Trends in the incidence of new-onset hypertensive disorders of pregnancy in rural and urban areas

December 2023—Efforts to develop biomarkers that help predict risk factors for preeclampsia/eclampsia and to better understand the trends and implications related to new-onset hypertensive disorders in pregnancy have grown. New-onset hypertension arising during pregnancy (gestational hypertension and preeclampsia/eclampsia) is associated with coronary heart disease, heart failure, stroke, and other cardiovascular-related mortality. Hypertensive disorders of pregnancy have grown into major public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. The authors conducted a study to describe contemporary trends in new-onset hypertensive disorders of pregnancy in the United States. They conducted a serial cross-sectional analysis of 51,685,525 live births to women aged 15 to 44 years, from 2007 to 2019, using the Centers for Disease Control and Prevention’s natality database. Women who had new-onset gestational hypertension and preeclampsia/eclampsia were included in the analysis. The authors calculated the age-adjusted incidence per 1,000 live births overall and by urbanization status (rural or urban). They also used joinpoint software to identify inflection points and calculate the rate of change. They employed rate ratios to compare the relative incidence of new-onset hypertensive disorders of pregnancy in rural versus urban areas. The results showed that incidences of the disorders increased in rural areas (48.6 to 83.9) and urban areas (37 to 77.2) during the study period. The authors found that the rate of annual increase in new-onset hypertensive disorders of pregnancy was more rapid after 2014, with a greater increase in urban versus rural areas. This significant increase was observed in each self-identified racial and ethnic group and U.S. region. The rate ratios in rural and urban areas decreased from 1.31 in 2007 to 1.09 in 2019. The authors concluded that even though the rural-urban gap decreased during the study period, it reflected a greater increase in rates of hypertensive disorders of pregnancy among individuals in urban areas as opposed to improvements in rural outcomes. The incidence of new-onset hypertensive disorders of pregnancy doubled from 2007 to 2019. This study highlights the need for targeted interventions to improve the health of pregnant women and their children.

Cameron NA, Everitt I, Seegmiller LE, et al. Trends in the incidence of new-onset hypertensive disorders of pregnancy among rural and urban areas in the United States, 2007 to 2019. J Am Heart Assoc. 2022. doi:10.1161/JAHA.121.023791

Correspondence: Dr. Sadiya S. Khan at s-khan-1@northwestern.edu