Severe Maternal Morbidity Associated with Hypertensive Disorders in Pregnancy in the United States

Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
Hypertension in Pregnancy (Impact Factor: 1.41). 02/2003; 22(2):203-12. DOI: 10.1081/PRG-120021066
Source: PubMed


This study was to report the incidence of severe maternal morbidity associated with hypertensive disorders of pregnancy in the United States.
We used data from the National Hospital Discharge Survey, a nationally representative sample of discharge records, from 1988 to 1997. The database consisted of approximately 300,000 deliveries, which represented 39 million births during the 10-year period.
The overall incidence of hypertensive disorders in pregnancy was 5.9% [95% confidence interval (CI): 5.2 to 6.5%]. Eclampsia was reported at 1.0 per 1,000 deliveries (95% CI: 0.8 to 1.2). The incidence of eclampsia, severe preeclampsia, and superimposed preeclampsia remained unchanged during the 10-year period. Women with preeclampsia and eclampsia had a 3- to 25-fold increased risk of severe complications, such as abruptio placentae, thrombocytopenia, disseminated intravascular coagulation, pulmonary edema, and aspiration pneumonia. More than half of women with preeclampsia and eclampsia had cesarean delivery. African American women not only had higher incidence of hypertensive disorders in pregnancy but also tended to have a greater risk for most severe complications. Preeclamptic and eclamptic women younger than 20 years or older than 35 years had substantially higher morbidity.
Preeclampsia and eclampsia carry a high risk for severe maternal morbidity. Compared to Caucasians, African Americans have higher incidence of hypertensive disorders in pregnancy and suffer from more severe complications.

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    • "These individuals develop mild symptoms of the disease with favorable fetal and maternal outcomes [9] [10]. In contrast, individuals who develop the disease before 34 weeks of gestation experience more severe symptoms, followed by increased fetal and maternal mortality and morbidity [9] [10] [11]. These two different presentations of preeclampsia are subsequent of different pathogenesis mechanisms. "

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    • "However, the peripartum period represents also a time of high risk for women to develop physiological and mental disorders that are particularly associated with those peripartum adaptations. Thus, 0.5–5% of pregnant women will develop preeclampsia after 20 weeks of pregnancy [5] [6] and about 18% will be diagnosed with gestational diabetes between week 24 and 28 of pregnancy [7]. A varying high percentage of women will also be affected by perinatal mental disorders such as postpartum blues (30–75%) [8], the more long-lasting postpartum depression (10–22%) [9] [10] and postpartum anxiety (5–12%) [11] [12], or in even more serious cases postpartum psychosis (1-2%) [13]. "
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    ABSTRACT: The time of pregnancy, birth, and lactation, is characterized by numerous specific alterations in several systems of the maternal body. Peripartum-associated changes in physiology and behavior, as well as their underlying molecular mechanisms, have been the focus of research since decades, but are still far from being entirely understood. Also, there is growing evidence that pregnancy and lactation are associated with a variety of alterations in neural plasticity, including adult neurogenesis, functional and structural synaptic plasticity, and dendritic remodeling in different brain regions. All of the mentioned changes are not only believed to be a prerequisite for the proper fetal and neonatal development, but moreover to be crucial for the physiological and mental health of the mother. The underlying mechanisms apparently need to be under tight control, since in cases of dysregulation, a certain percentage of women develop disorders like preeclampsia or postpartum mood and anxiety disorders during the course of pregnancy and lactation. This review describes common peripartum adaptations in physiology and behavior. Moreover, it concentrates on different forms of peripartum-associated plasticity including changes in neurogenesis and their possible underlying molecular mechanisms. Finally, consequences of malfunction in those systems are discussed.
    Neural Plasticity 05/2014; 2014(5190):574159. DOI:10.1155/2014/574159 · 3.58 Impact Factor
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    • "HD increase the risk of severe complications by 3 to 25 times, e.g. placental abruption, thrombocytopenia, disseminated intravascular coagulation, acute pulmonary edema, cerebrovascular disorders and other conditions, in comparison to women without hypertension [3,5,6]. The contrast between low or very low maternal mortality ratios (MMR) in high-income countries, compared to low-income or middle-income countries with high MMR has been attributed to the quality of obstetric care, patient access to hospitalization, qualification of health professionals and structural resources, including the input and availability of intensive care units [7-9]. "
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    ABSTRACT: Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica(R), an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.
    Reproductive Health 01/2014; 11(1):4. DOI:10.1186/1742-4755-11-4 · 1.88 Impact Factor
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