Hypertension
Poster Session 4
Medhavi Bhasin, MD,MA (she/her/hers)
Advocate Lutheran General Hospital
Park Ridge, IL, United States
Rachel Harrison, MD (she/her/hers)
Advocate Aurora Health
Oak Lawn, IL, United States
Kavya Shivashankar, MD
Resident Physician
University of Illinois Hospital
Chicago, IL, United States
Yara El Helou, MD
Resident
University of Illinois at Chicago
Chicago, IL, United States
Michael Earing, MD
Advocate Aurora Health
Chicago, IL, United States
Calla Holmgren, MD
AAH Lutheran General Hospital
Park Ridge, IL, United States
To determine the rate of hypertensive disorders of pregnancy (HDP) among women with adult congenital heart disease (ACHD).
Study Design: This is a retrospective cohort study performed using the National Inpatient Sample Database from the Healthcare Cost and Utilization Project from 2017-2019. ICD-10 codes were used to identify subjects with and without ACHD for comparison. Subjects with delivery encounters associated with their admission were included. Subjects were excluded if gestational age was unknown or < 20 weeks. 2,214,562 patients were included in the analysis, 2,409 (0.1%) of whom had ACHD. Baseline characteristics and the presence and type of HDP in the two groups were compared via t-tests, chi-squared analysis, and logistic regression analysis.
Results:
Those with ACHD were more likely to be younger, non-Hispanic white, obese, tobacco users, or to have diabetes or a hypertensive disorder. They were less likely to have public insurance and more likely to deliver at large, private, and urban teaching hospitals. ACHD was associated with increased rates of HDP; HDP affected 16.4% of subjects with ACHD vs. 12.0% of subjects without (p< 0.001). When stratifying by type of HDP, the difference between the two groups was only statistically significant for severe HDP – preeclampsia with severe features (3.2% vs. 2.3%, p=0.003), superimposed preeclampsia with severe features (2.7% vs. 1.0%, p< 0.001), and HELLP/eclampsia (0.9% vs. 0.3%, p< 0.001) – not for gestational hypertension or preeclampsia without severe features (6.8% vs 6.1%, p=0.177 & 1.9% vs 1.7%, p=0.411). In adjusted analysis, subjects with ACHD remained more likely than non-ACHD subjects to have any HDP (aOR 1.23, 95% CI 1.10-1.38), superimposed preeclampsia with severe features (aOR 1.77, 95% CI 1.33-2.37), and HELLP/eclampsia (aOR 2.46, 95% CI 1.60-3.79) compared to non-ACHD subjects.
Conclusion:
Pregnant patients with ACHD have an increased risk for HDP and are specifically at higher risk for development of superimposed preeclampsia with severe features and HELLP/eclampsia compared to patients without ACHD.