(907) Hereditary Hemorrhagic Telangiectasia: pregnancy and delivery-specific considerations and outcomes

Objective: Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy and delivery specific data remains limited in this patient population. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT.

Study Design: This retrospective study used the National Readmissions Database to identify patients with HHT diagnosis on delivery hospitalizations between 2010-2020. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included non-transfusion SMM, preterm birth, cesarean delivery, respiratory bleeding, and cerebrovascular complications. Trends in the prevalence of HHT at delivery hospitalization were assessed with logistic regression. Logistic regression analyses, adjusting for age, payer, zip code income, hospital size and teaching status, were also used to produce adjusted relationships between HHT status and outcomes.

Results: The cohort of 19,812,073 delivered pregnancies corresponded to a national estimate of 40,819,063. Of those, 1,132 (2.7 per 100,000) had a diagnosis of HHT. A steady rise in HHT diagnosis rate during pregnancy from 2010 to 2020 (1.7 per 100,000 in 2010, 4.0 per 100,000 in 2020, p< 0.001 for trend) was seen. Patients with HHT were significantly more likely to experience SMM compared to patients without HHT (7.3% vs 1.7%, p< 0.001). Additionally, rates of preterm birth (13.4% vs 8.3%), cesarean delivery (40.8% vs 32.9%), respiratory bleeding (1.8% vs < 0.1%) and cerebrovascular complications (0.7% vs < 0.1%) were higher in patients with HHT than non-HHT patients (all p< 0.001; Panel A). After adjusting for patient and facility characteristics, these associations remained significant (Panel B).

Conclusion: Patients with HHT have higher rates of severe maternal morbidity and adverse delivery outcomes when compared to the baseline population. As the prevalence of HHT during pregnancy is increasing, guidelines for pregnancy and delivery management in these patients are warranted.