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Am J Perinatol 2025; 42(14): 1885-1896
DOI: 10.1055/a-2547-4267
Original Article

Risk Factors, Trends, and Outcomes Associated with Rural Delivery Hospitalizations Complicated by Hypertensive Disorders of Pregnancy

Authors

  • Mary M. Carmack

    1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

  • Joel Agarwal

    1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

  • Timothy Wen

    2   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California

  • Yongmei Huang

    1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

  • Alexander M. Friedman

    1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York

Funding None.
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Abstract

Objective

Hypertensive disorders of pregnancy (HDP) may account for a considerable and growing clinical burden at rural hospitals which have been providing fewer obstetric services over the past two decades. The objectives of this analysis were to evaluate trends, risk factors, and outcomes associated with HDP during delivery hospitalizations at rural hospitals in the United States.

Study Design

The 2000 to 2020 National Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations at rural hospitals to women 15 to 54 years of age with and without HDP (including preeclampsia and gestational hypertension) were identified. Trends in HDP were characterized with joinpoint regression and estimated as the average annual percent change (AAPC) with 95% confidence intervals (CIs). The associations between (i) HDP risk factors and HDP and (ii) HDP and adverse maternal outcomes were estimated with adjusted logistic regression models.

Results

Among 8,885,683 deliveries that occurred at rural hospitals, the proportion with a HDP diagnosis increased significantly from 6.0% in 2000 to 11.1% in 2020 (AAPC: 3.1%; 95% CI: 2.8 and 3.4%). Preeclampsia with severe features (AAPC: 5.5%; 95% CI: 4.8 and 6.2%) and superimposed preeclampsia (AAPC: 6.5%; 95% CI: 5.6 and 7.5%) underwent the largest relative increases over the study period. Obesity, pregestational diabetes, chronic hypertension, multiple gestation, and chronic kidney disease were all associated with increased adjusted odds of HDP. HDP diagnoses were significantly associated with severe maternal morbidity (SMM), transfusion, stroke, and disseminated intravascular coagulation. The proportion of overall delivery SMM associated with HDP more than doubled from 11.3% in 2000 to 24.7% in 2020.

Conclusion

Among delivery hospitalizations at rural hospitals, HDP, and associated risk factors increased significantly over the study period. Deliveries with HDP accounted for an increasing proportion of population-level SMM. HDP is a major, growing contributor to maternal risk and adverse outcomes during deliveries at rural hospitals.

Key Points

  • Hypertensive disorders accounted for an increasing proportion of population-level severe morbidity.

  • Hypertensive disorders increased among rural delivery hospitalizations.

  • Risk factors associated with hypertensive disorders increased among rural delivery hospitalizations.

Keywords

maternal safety - maternal outcomes - hypertensive disorders - rural obstetric care

Supplementary Material



Publication History

Received: 15 November 2024

Accepted: 26 February 2025

Accepted Manuscript online:
27 February 2025

Article published online:
27 March 2025

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