Risk of Stillbirth after Antepartum Hospitalization for Hypertensive Diseases of PregnancyFunding A.M.F. is supported by a career development award (K08HD082287) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
29 July 2019
08 August 2019
28 September 2019 (online)
Objective To determine if women with an antepartum admission for hypertensive diseases of pregnancy (HDP) were at increased risk for stillbirth.
Study Design This study utilized the 2010 to 2014 Nationwide Readmissions Database. Antepartum admissions with HDP were identified and linked to subsequent delivery hospitalizations. Delivery hospitalizations with HDP without a preceding antepartum HDP admission were also identified. Risk for stillbirth, abruption, or both was compared between these two groups.
Results An estimated 382,621 deliveries with an HDP diagnosis were identified of which 14,857 (3.9%) had a preceding antepartum admission for HDP. Stillbirth occurred in 7.8 per 1,000 delivery hospitalizations complicated by HDP with risk higher with a preceding HDP antepartum admission in both unadjusted (1.1 vs. 0.8%, risk ratios [RR] 1.46, 95% confidence interval [CI] 1.24–1.70) and adjusted (adjusted risk ratios [aRR] 1.24, 95% CI 1.06, 1.46) analyses. Abruption occurred in 19.6 per 1,000 delivery hospitalizations complicated by HDP with risk higher with a preceding HDP antepartum admission in both unadjusted (2.5 vs. 1.9%, RR 1.30, 95% CI 1.17–1.44) and adjusted (aRR 1.24, 95% CI 1.11, 1.37) analyses. Risk for combined abruption and stillbirth did not differ significantly.
Conclusion In this analysis, prior antenatal hospitalization was associated with increased risk for stillbirth among women with HDP.
This study was presented at the 2019 Society for Maternal-Fetal Medicine Annual Meeting in Las Vegas, Nevada.
- 1 Wagner SJ, Barac S, Garovic VD. Hypertensive pregnancy disorders: current concepts. J Clin Hypertens (Greenwich) 2007; 9 (07) 560-566
- 2 Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DAJTL. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet 2005; 366 (9499): 1797-1803
- 3 McDonald SD, Malinowski A, Zhou Q, Yusuf S, Devereaux PJ. Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. Am Heart J 2008; 156 (05) 918-930
- 4 Magnussen EB, Vatten LJ, Smith GD, Romundstad PRJO. Hypertensive disorders in pregnancy and subsequently measured cardiovascular risk factors. Obstet Gynecol 2009; 114 (05) 961-970
- 5 Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113 (06) 1299-1306
- 6 Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 25 (04) 391-403
- 7 Martin JA, Hamilton BE, Ventura SJ. , et al. Births: final data for 2009. Natl Vital Stat Rep 2011; 60 (01) 1-70
- 8 Gibbins KJ, Silver RM, Pinar H. , et al. Stillbirth, hypertensive disorders of pregnancy, and placental pathology. Placenta 2016; 43: 61-68
- 9 Basso O, Rasmussen S, Weinberg CR, Wilcox AJ, Irgens LM, Skjaerven R. Trends in fetal and infant survival following preeclampsia. JAMA 2006; 296 (11) 1357-1362
- 10 The Task Force on Hypertension in Pregnancy. Hypertension in Pregnancy. Available at: https://www.acog.org/~/media/Task Force and Work Group Reports/public/HypertensioninPregnancy.pdf . Accessed April 1, 2019
- 11 2016 Introduction to the NRD. Available at: https://www.hcup-us.ahrq.gov/db/nation/nrd/Introduction_NRD_2010-2016.jsp . Accessed February 23, 2019
- 12 Kuklina EV, Whiteman MK, Hillis SD. , et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12 (04) 469-477
- 13 Flenady V, Koopmans L, Middleton P. , et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377 (9774): 1331-1340
- 14 Coletta J, Simpson LL. Maternal medical disease and stillbirth. Clin Obstet Gynecol 2010; 53 (03) 607-616
- 15 Silver RM, Varner MW, Reddy U. , et al. Work-up of stillbirth: a review of the evidence. Am J Obstet Gynecol 2007; 196 (05) 433-444
- 16 Stillbirth Collaborative Research Network Writing G. Causes of death among stillbirths. JAMA 2011; 306 (22) 2459-2468