Hypertension in Women of Reproductive Age in the
United States: NHANES 1999-2008
Brian T. Bateman1*, Kate M. Shaw2, Elena V. Kuklina2, William M. Callaghan3, Ellen W. Seely4,
Sonia Herna ´ndez-Dı ´az5
1Division of Obstetric Anesthesia, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, United States of America, 2Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 3Division of Reproductive Health, National Center for Chronic Disease Prevention
and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 4Department of Medicine, Brigham and Women’s Hospital,
Harvard Medical School, Boston, Massachusetts, United States of America, 5Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United
States of America
Objective: To examine the epidemiology of hypertension in women of reproductive age.
Methods: Using NHANES from 1999–2008, we identified 5,521 women age 20–44 years old. Hypertension status was
determined using blood pressure measurements and/or self-reported medication use.
Results: The estimated prevalence of hypertension in women of reproductive age was 7.7% (95% confidence interval (CI):
6.9%–8.5%). The prevalence of anti-hypertensive pharmacologic therapy was 4.2% (95% CI 3.5%–4.9%). The prevalence of
hypertension was relatively stable across the study period; the age and race adjusted odds of hypertension in 2007–2008
did not differ significantly from 1999–2000 (odds ratio 1.2, CI 0.8 to 1.7, p=0.45). Significant independent risk factors
associated with hypertension included older age, non-Hispanic black race (compared to non-Hispanic whites), diabetes
mellitus, chronic kidney disease, and higher body mass index. The most commonly used antihypertensive medications
included diuretics, angiotensin-converting enzyme inhibitors (ACE), and beta blockers.
Conclusion: Hypertension occurs in about 8% of women of reproductive age. There are remarkable differences in the
prevalence of hypertension between racial/ethnic groups. Obesity is a risk factor of particular importance in this population
because it affects over 30% of young women in the U.S., is associated with more than 4 fold increased risk of hypertension,
and is potentially modifiable.
Citation: Bateman BT, Shaw KM, Kuklina EV, Callaghan WM, Seely EW, et al. (2012) Hypertension in Women of Reproductive Age in the United States: NHANES
1999-2008. PLoS ONE 7(4): e36171. doi:10.1371/journal.pone.0036171
Editor: Yan Gong, University of Florida, United States of America
Received January 23, 2012; Accepted April 2, 2012; Published April 30, 2012
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for
any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: This work was supported by National Institutes of Health T32 training grant GM007592 (BTB). The funders had no role in study design, data collection
and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: BBateman@partners.org
Hypertension is a highly prevalent chronic medical condition
affecting more than 65 million people in the United States [1,2]. It
is the leading reason for physician office visits, accounting for
approximately 42 million ambulatory encounters each year, and is
among the leading indications for the use of prescription drugs .
While in general, women of reproductive age have relatively low
rates of hypertension, it presents important clinical implications
and challenges  in this population, not only because of its role as
a risk factor for cardiovascular disease, but also because of the
issues associated with this condition and its treatment in
It is well established that young women with hypertension have
increased risk for cardiovascular disease in both the short and the
long term . Rates of cardiovascular disease in young women in
the U.S. appear to be increasing . Analysis of U.S. vital statistics
data showed that the coronary heart disease mortality rate for
women age 35–44 increased on average 1.3% per year from
1997–2002; this was the only subpopulation for which the rate had
increased, suggesting the need for further study of risk factors in
Equally important, hypertension, estimated to complicate up to
5% of the estimated 4 million pregnancies in the United States
each year, is a major source of maternal and fetal morbidity
[7,8]. Between 10 to 25% of women with chronic hypertension
will develop superimposed preeclampsia [9,10,11]. The risk of
placental abruption is also substantially elevated, approaching 2%
in some series [9,10]. Life-threatening maternal outcomes,
including stroke [12,13,14], renal failure [12,14], pulmonary
edema [12,14], and death [12,14] are also significantly increased
in women with chronic hypertension. Adverse fetal outcomes
associated with chronic hypertension include preterm birth and
intrauterine growth restriction [10,11] and the perinatal mortality
PLoS ONE | www.plosone.org1 April 2012 | Volume 7 | Issue 4 | e36171
rate in offspring of mothers with chronic hypertension is elevated
approximately 2 to 4-fold [11,14,15,16].
Understanding the epidemiology of hypertension in young
women may help clinicians identify important modifiable risk
factors and public health officials target interventions, which in
turn may improve pregnancy outcomes and prevent cardiovascu-
lar disease. There are no recent nationwide data focusing on the
epidemiology of hypertension in this important group. The
purpose of this study is (1) to examine prevalence of hypertension
in women of reproductive age, (2) to identify factors independently
associated with hypertension in this group, and (3) to analyze the
medications used to treat hypertension in this population utilizing
data from the National Health and Nutrition Examination Survey
NHANES is a nationally representative cross-sectional survey
designed to assess the health and nutritional status of the U.S.
civilian, non-institutionalized population. NHANES became a
continuous survey in 1999; data are released in 2-year cycles. All
NHANES surveys include a personal interview in the household
and a detailed physical examination in a mobile examination
center (MEC). Additional data on the survey design, question-
naires, and laboratory methods are available elsewhere. (Centers
for Disease Control and Prevention, National Center for Health
Statistics. National Health and Nutrition Examination Survey.
Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed
May 9, 2011.).
To reliably estimate prevalence of hypertension and anti-
hypertensive medication use among women of reproductive age,
data were analyzed from 5 survey periods collected from 1999 to
2008. The overall examination survey response rates ranged from
75% to 80%. During 1999–2008, 5,909 women aged 20–44
participated in the household and MEC examination. Among
those, 5,521 participants had complete data to determine
hypertension status and medication usage.
Hypertension was defined using blood pressure measurements
and/or self-reported anti-hypertensive use. Blood pressure was
measured by a physician using an appropriately sized cuff.
Volunteers rested at least 5 minutes before the blood pressure
readings were obtained. The average of up to 3 blood pressure
measurements, obtained during the MEC examination, was used
to assess blood pressure. Participants with an average systolic
blood pressure $140 mmHg and/or an average diastolic blood
pressure $90 mmHg or those who self-reported currently taking
prescribed medication for high blood pressure were defined as
Prescription medication for respondents was obtained from the
prescription medication section of the household interview.
Participants were asked whether they had taken any prescription
medications in the previous 30 days. Interviewers recorded
prescriptions using their medication bottles. Medications recorded
by NHANES are coded and classified using the Lexicon PlusH
database. (Cerner, Multum, Inc. Available at: http://www.
multum.com/Lexicon.htm. Accessed: May 9, 2011.) Anti-hyper-
tensives were defined as angiotensin converting enzyme (ACE)
inhibitors, angiotensin II receptor antagonists (ARBs), antiadre-
nergic agents, beta-blockers, calcium channel blockers, and
diuretics. Combination drugs were re-categorized into the single
medication classes for each of the constituents of the combination
(i.e., each constituent was counted towards the total number
exposed for the class of the components). For those taking more
than one medication, each medication was separately counted
towards the total for each class. Prescription medication was only
examined among those who self-reported taking anti-hyperten-
For each participant, potential risk factors for hypertension were
abstracted from the dataset. These included age (grouped into 20–
34, 35–39, and 40–44 years old) and race/ethnicity (grouped into
white (non-Hispanic), black (non-Hispanic), Mexican-American,
and other), diabetes mellitus (defined as self-reported disease),
chronic kidney disease (defined as self-reported disease or a
glomerular filtration rate (GFR) of 15–60 mL/min per 1.73 m2,
with GFR calculated as previously described  ), average
Table 1. Characteristics of reproductive aged women, 20–44,
United States, National Health and Nutrition Examination
Characteristic% (95% CI)1
40–44 22.1 (20.7–23.6)
White, non-Hispanic65.5 (62.2–68.6)
Black, non-Hispanic 13.1 (11.2–15.2)
Chronic kidney disease3
Average alcohol use4
#1 drink/day43.8 (41.0–46.6)
.1 drink/day24.0 (22.1–26.0)
Oral contraceptive use5
Body mass index (kg/m2)6
$35 15.5 (14.1–17.0)
Hypertension by survey cycle7
Overall (1999–2008)7.7 (6.9–8.5)
1. Weighted estimates calculated using the examination weight; 95%
2. Diabetes was defined using self-reported diabetes.
3. Chronic kidney disease was defined using self-reported disease or a
glomerular filtration rate of 15–60 mL/min per 1.73 m2.
4. Average number of drinks per day over the past year.
5. Self-reported oral contraceptive use.
6. Height and weight were measured during the examination.
7. Hypertension was defined as an average systolic blood pressure
$140 mmHg, average diastolic blood pressure $90 mmHg, or self-reported
currently taking anti-hypertensives.
Chronic Hypertension in Women of Reproductive Age
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Table 2. Prevalence of hypertension1and unadjusted and adjusted odds ratios (OR) for risk of hypertension by characteristics of
reproductive aged women, 20–44, United States, National Health and Nutrition Examination Survey, 1999–2008.
Hypertension Unadjusted OR
% (95% CI)2
OR (95% CI) OR (95% CI)
20–34 2.7 (2.1–3.4)Referent Referent
35–39 10.0 (8.1–12.2)4.0 (3.1–5.3)
,0.01 3.3 (2.1–5.2)
40–44 18.4 (15.6–21.5) 8.2 (5.9–11.5)
,0.01 8.2 (5.0–13.3)
White, non-Hispanic6.6 (5.5–7.8)Referent Referent
Black, non-Hispanic16.6 (14.6–18.8) 2.8 (2.2–3.6)
,0.01 2.3 (1.5–3.5)
Mexican-American4.4 (3.3–6.0)0.7 (0.5–1.0)0.03 0.6 (0.3–1.0)0.04
Other 6.4 (4.1–9.9) 1.0 (0.6–1.6)0.92 0.9 (0.5–1.6)0.65
35.2 (27.0–44.3)7.3 (4.9–10.9)
,0.01 3.4 (1.9–6.1)
Chronic kidney disease5,6
21.6 (14.7–30.4)3.6 (2.2–5.9)
,0.012.2 (1.1–4.4) 0.03
Average alcohol use (over
None 9.4 (7.7–11.4) ReferentReferent
#1 drink/day 7.1 (5.6–8.9)0.7 (0.5–1.0) 0.091.1 (0.7–1.7)0.84
.1 drink/day7.1 (5.7–8.8)0.7 (0.5–1.0) 0.07 0.9 (0.5–1.3)0.48
8.9 (7.0–11.3)1.3 (0.9–1.7) 0.13 1.0 (0.6–1.4)0.84
Oral contraceptive use6
2.3 (1.3–4.2)0.3 (0.1–0.5)
Body mass index (kg/m2)
25–,30 6.2 (4.7–8.1)1.8 (1.2–2.9)
,0.01 2.0 (1.1–3.5)0.03
30–,359.8 (7.8–12.3)3.0 (2.0–4.6)
$3518.9 (16.5–21.6) 6.5 (4.4–9.6)
1. Hypertension was defined as an average systolic blood pressure $140 mmHg, average diastolic blood pressure $90 mmHg, or self-reported currently taking anti-
2. Weighted estimates calculated using the examination weight; 95% confidence intervals.
3. Adjusted for all variables in the table.
4. Self-reported diabetes.
5. Self-reported disease or a glomerular filtration rate of 15–60 mL/min per 1.73 m2.
6. Yes versus no.
Figure 1. Prevalence1of hypertension2by body mass index (BMI)and for reproductive aged women, 20–44, United States, National
Health and Nutrition Examination Survey, 1999–2008. 1. Weighted estimates calculated using the examination weight and 95% confidence
intervals. 2. Hypertension was defined as an average systolic blood pressure $140 mmHg, average diastolic blood pressure $90 mmHg, or self-
reported currently taking anti-hypertensives.
Chronic Hypertension in Women of Reproductive Age
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Chronic Hypertension in Women of Reproductive Age
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alcohol use over the past year (grouped as none, #1 drink/day,
.1 drink/day), active cigarette smoking, self-reported oral con-
traceptive use, and body mass index (BMI) (obtained from height
and weight measurement during the exam using standardized
techniques and equipment  and grouped as ,25 kg/m2, 25-
,30 kg/m2, 30-,35 kg/m2, and $35 kg/m2). The prevalence of
hypertension in each of these groups and the univariate association
of these variables and hypertension was determined. All variables
were then entered into a logistic regression model to identify
independent associations with hypertension. Logistic regression
was also used to assess for changes in the prevalence of
hypertension during the study period, comparing the prevalence
in1999–2000 with each subsequent two-year study interval.
To account for the complex, multistage probably survey design,
analyses were conducted using SAS (version 9.2) callable
SUDAAN (release 10.0). Results are described as weighted
prevalence and unadjusted and adjusted weighted odds ratios.
Statistical significance was defined as an alpha level ,0.05.
Using NHANES from 1999–2008, we identified 5,521 women
age 20–44 years old from whom blood pressure measurements
were obtained. The baseline characteristics of this group are
shown in Table 1. About 65% of the cohort were non-Hispanic
whites, 13% non-Hispanic blacks and 10% Mexican-Americans.
The estimated prevalence of diabetes was 2.4% and of chronic
kidney disease was 2.9%. Approximately 25% were cigarette
smokers, 24% drank on average more than one alcoholic drink
each day, and 19% reported using birth control pills. Only 42%
were of normal weight or lower; 26% were overweight, 16% had
class I obesity (BMI 30–35 kg/m2), and 15% had class II or III
obesity (BMI$35 kg/m2). The prevalence of hypertension was
relatively stable across the study period allowing for the
examination of the aggregate data for all 5 survey cycles. The
overall estimated prevalence of hypertension was 7.7% (95%
confidence interval (CI): 6.9%–8.5%).
Table 2 shows the prevalence of hypertension by demographics
and comorbidities and the univariate association of each of these
characteristics with hypertension. The prevalence of hypertension
increased significantly with age, from 2.7% in women age 20–34
to 18.4% in women age 40–44. Non-Hispanic blacks were more
than twice as likely as non-Hispanic whites to have hypertension.
Other patient characteristics associated with hypertension includ-
ed diabetes, chronic kidney disease, and higher BMI. Self-reported
oral contraceptive (OCP) use was inversely associated in the
univariate analysis; however, the association attenuated after
adjusting for age since OCP use was inversely correlated with age
(compared to 20–34 year olds, the odds ratio for OCP use was
0.93 for 35–39 year olds and 0.32 for 40–44 year olds). The results
of a multivariate logistic regression analysis, with all variables
entered into the model, are also shown in Table 2.
Because increasing BMI was the most significant modifiable risk
factor identified in our analysis, we explored the relationship of
BMI and hypertension in more detail(Figure 1). There was a near
linear increase in the prevalence of hypertension with rising BMI
from 25. As shown in Figure 2, more than a quarter of all Black,
non-Hispanic women had stage II or greater obesity. Blacks had
higher prevalence of hypertension at every BMI compared with
whites; blacks with a BMI greater than or equal to 35 kg/m2had a
prevalence of 26.5%.
In this study, 4.2% (95% CI 3.5%–4.9%) of women of
reproductive age used anti-hypertensive pharmacologic therapy.
Table 3 shows the distribution of the anti-hypertensive used by
patients reporting treatment for hypertension. Among anti-
hypertensive users, the most commonly used medication classes
included diuretics (47.9%), ACEIs (44.0%), and beta-blockers
(23.3%). For women taking ACEIs and/or ARBs, the prevalence
of diabetes was 19.2% (95% CI 13.0–27.4).
This study uses data from the NHANES 1999 to 2008 sample to
define the prevalence and risk factors for hypertension for women
of reproductive age in the United States, and to describe the
relative prevalence of the medications used to treat hypertension in
this group. We report an overall hypertension prevalence of 7.7%,
which was relatively stable across the 10-year study period.
Advancing age, non-Hispanic black race/ethnicity, diabetes,
chronic kidney disease, and obesity were independently associated
with hypertension in this population. An estimated 4.9% of
women of reproductive age used antihypertensive pharmacologic
therapy. Among anti-hypertensive users, the most common
medication classes included diuretics (47.9%), ACE inhibitors
(44.0%), and beta blockers (23.3%).
The most significant modifiable risk factor for hypertension that
we identified in our analysis was obesity. After adjustment for
other variables, women with class I obesity were approximately 4-
fold and women with class II/III obesity approximately 6-fold
more likely to be hypertensive than their normal weight
counterparts. As shown in Figure 1, we also observed that the
prevalence of hypertension increased in a near linear fashion with
BMI and only started to plateau as BMI approached 40. The
rising prevalence of obesity in pregnancy, suggests obstetri-
Figure 2. Prevalence1of hypertension2(A) by body mass index (B) and distribution of BMI for white and black, non-Hispanic
reproductive aged women, 20–44, United States, National Health and Nutrition Examination Survey, 1999–2008. 1. Weighted
estimates calculated using the examination weight; 95% confidence intervals. 2. Hypertension was defined as an average systolic blood pressure
$140 mmHg, average diastolic blood pressure $90 mmHg, or self-reported currently taking anti-hypertensives.
Table 3. Anti-hypertensive use1of reproductive aged
women, 20–44, United States, National Health and Nutrition
Examination Survey, 1999–2008.
% (95% CI)3
Angiotensin-converting enzyme inhibitor 44.0 (36.1–52.3)
Angiotensin receptor blockers20.4 (13.8–29.1)
Calcium channel blockers20.3 (15.3–26.5)
1. Medications were examined among participants who reported taking
prescription anti-hypertensives within the past month and the medication
container was seen by the interviewer.
2. Categories not mutually exclusive. Combination drugs were reclassified into
individual medication classes. The estimate for antiadrenergic agents is not
reportable because the relative standard error exceeds 30%.
3. Weighted estimates calculated using the examination weight among
participants taking anti-hypertensives; 95% confidence intervals.
4. Including labetolol.
Chronic Hypertension in Women of Reproductive Age
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cians will be increasingly confronted with the issues of hyperten-
Non-Hispanic Black race/ethnicity and advancing age were
non-modifiable patient characteristics associated with increased
risk for hypertension. Multiple studies in the general population
have demonstrated that hypertension in blacks is more prevalent,
earlier in onset, and more severe [21,22]. Hypertension, in part,
contributes to the large disparities between white and blacks in the
US in rates of cardiovascular disease  and adverse pregnancy
outcomes . Developing preventive measures for hypertension
aimed at this group may be one mechanism to help decrease these
disparities. It should be noted that nearly one-half of young black
women were obese in this sample; preventative measures might
consider targeting obesity in this population.
The increased prevalence of hypertension with advanced age,
likewise, may explain some of the increased risk for some
pregnancy complications in women of advanced maternal age.
The problem of chronic hypertension in pregnancy is likely to
become more common as the numbers of mothers of advanced
age increases .
Approximately 5% of women of reproductive age took
antihypertensive medications. Most common among these were
diuretics, ACE inhibitors, and beta blockers. Recent data
regarding the risks of congenital malformations associated with
antihypertensive exposure during the first trimester have been
mixed, with some studies reporting increased risk while others
suggest that any observed risk is attributable to the underlying
[26,27,28,29,30,31,32]. The Food and Drug Administration
currently categorizes most antihypertensives as category C–
meaning that animal studies either show an adverse effect or are
lacking and no well-controlled human studies exist, and that
medication should only be given when the benefit justifies the
potential risk to the fetus . As about half of all pregnancies in
the United States are unintended , medications prescribed to
women of reproductive age are likely to be frequently taken during
the first trimester. Given the high prevalence of antihypertensive
medication utilization in women of reproductive age, further
research into the safety of these medications in pregnancy is
merited to inform the selection of the safest antihypertensive for
We found a relatively stable rate of hypertension across the
study period. Data suggest that the rate of obesity in the U.S. has
begun to plateau . As shown in our study, obesity is an
extremely important risk factor for hypertension in this population,
and the lack of rise in obesity rates may explain the lack of rise in
the prevalence of hypertension.
Results reported in this study should be interpreted with the
following limitations in mind. First, there are several patient
characteristics that are known to be associated with hypertension
from previous studies, including heavy alcohol use , OCPs use
[36,37,38], and cigarette smoking , which were not significant
in our analysis of the NHANES sample. It may be that the effect of
alcohol and smoking in contributing to hypertension occurs only
after many years of exposure and thus the association is less robust
in young women, such as those considered in our study or that
some women with hypertension avoid tobacco and alcohol. In this
study, OCP use in the univariate analysis was protective; however,
OCP use was inversely correlated with advancing age, and after
adjustment for this and other patient characteristics, OCP use was
not significantly associated with hypertension. It is also likely that
clinicians are reluctant to prescribe OCP to hypertensive women
or discontinue OCPs if women develop hypertension, which would
lead to a lack of association or even an inverse association. An
additional limitation is that the lower age limit considered is 20 (as
certain variables of interest are not reported in the NHANES for
younger women). Likewise, in keeping with most epidemiologic
studies of women of reproductive age, we defined the upper age
limit for our population at 44–but women older than this can
become pregnant through assisted reproduction, and hypertension
is likely even more prevalent in this group. We were not able to
analyze the effect of physical activity on the risk of hypertension, as
the questions used to ascertain activity changed during the study
period. Finally, NHANES is a cross-sectional study and it is
appropriate for describing prevalence of conditions and associa-
tions, but not temporal relationships. As with any observational
study, it has a limited role in establishing causality.
In conclusion, hypertension occurs in about 8% of women of
reproductive age. Obesity is a risk factor of particular importance
in this population because it affects over 30% of young women in
the U.S., is associated with more than a 4 fold increased risk of
hypertension, and is potentially modifiable. There are also
remarkable differences in the prevalence of hypertension between
racial/ethnic groups. Women of reproductive age are commonly
exposed to antihypertensive medications and data regarding the
fetal risks associated with first trimester exposure are conflicting; as
a large proportion of pregnancies are unplanned, further work is
needed to define the safest antihypertensive medications for these
The findings and conclusions in this report are those of the authors and do
not necessarily represent the official position of the Centers for Disease
Control and Prevention.
Conceived and designed the experiments: BTB KMS EVK WMC EWS
SHD. Performed the experiments: BTB KMS EVK. Analyzed the data:
BTB KMS EVK. Contributed reagents/materials/analysis tools: KMS
EVK. Wrote the paper: BTB KMS EVK WMC EWS SHD.
1.Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, et al. (2004) The burden
of adult hypertension in the United States 1999 to 2000: a rising tide.
Hypertension 44: 398–404.
Centers for Disease Control and Prevention (2011) Vital signs: prevalence,
treatment, and control of hypertension – United States, 1999–2002 and 2005–
2008. MMWR Morb Mortal Wkly Rep 60: 103–108.
Hsiao CJ, Cherry DK, Beatty PC, Rechtsteiner EA (2010) National Ambulatory
Medical Care Survey: 2007 summary. Natl Health Stat Report. pp 1–32.
Yoder SR, Thornburg LL, Bisognano JD (2009) Hypertension in pregnancy and
women of childbearing age. Am J Med 122: 890–895.
Daviglus ML, Stamler J, Pirzada A, Yan LL, Garside DB, et al. (2004) Favorable
cardiovascular risk profile in young women and long-term risk of cardiovascular
and all-cause mortality. JAMA 292: 1588–1592.
6.Ford ES, Capewell S (2007) Coronary heart disease mortality among young
adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates.
J Am Coll Cardiol 50: 2128–2132.
American College of Obstetricians and Gynecologists (2001) ACOG Practice
Bulletin. Chronic hypertension in pregnancy. ACOG Committee on Practice
Bulletins. Obstet Gynecol 98: suppl 177-185.
Sibai BM (2002) Chronic hypertension in pregnancy. Obstet Gynecol 100:
Sibai BM, Abdella TN, Anderson GD (1983) Pregnancy outcome in 211 patients
with mild chronic hypertension. Obstet Gynecol 61: 571–576.
10. Sibai BM, Lindheimer M, Hauth J, Caritis S, VanDorsten P, et al. (1998) Risk
factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes
among women with chronic hypertension. National Institute of Child Health
Chronic Hypertension in Women of Reproductive Age
PLoS ONE | www.plosone.org6 April 2012 | Volume 7 | Issue 4 | e36171
and Human Development Network of Maternal-Fetal Medicine Units. Download full-text
N Engl J Med 339: 667–671.
11. Rey E, Couturier A (1994) The prognosis of pregnancy in women with chronic
hypertension. Am J Obstet Gynecol 171: 410–416.
12. Kuklina EV, Ayala C, Callaghan WM (2009) Hypertensive disorders and severe
obstetric morbidity in the United States. Obstet Gynecol 113: 1299–1306.
13. Bateman BT, Schumacher HC, Bushnell CD, Pile-Spellman J, Simpson LL, et
al. (2006) Intracerebral hemorrhage in pregnancy: frequency, risk factors, and
outcome. Neurology 67: 424–429.
14. Gilbert WM, Young AL, Danielsen B (2007) Pregnancy outcomes in women
with chronic hypertension: a population-based study. J Reprod Med 52:
15. Jain L (1997) Effect of pregnancy-induced and chronic hypertension on
pregnancy outcome. J Perinatol 17: 425–427.
16. Ananth CV, Savitz DA, Bowes WA Jr. (1995) Hypertensive disorders of
pregnancy and stillbirth in North Carolina, 1988 to 1991. Acta Obstet Gynecol
Scand 74: 788–793.
17. Egan BM, Zhao Y, Axon RN (2010) US trends in prevalence, awareness,
treatment, and control of hypertension, 1988-2008. JAMA 303: 2043–2050.
18. Centers for Disease Control and Prevention (2007) Prevalence of chronic kidney
disease and associated risk factors – United States, 1999–2004. MMWR Morb
Mortal Wkly Rep 56: 161–165.
19. Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in
obesity among US adults, 1999-2008. JAMA 303: 235–241.
20. Kim SY, Dietz PM, England L, Morrow B, Callaghan WM (2007) Trends in
pre-pregnancy obesity in nine states, 1993–2003. Obesity (Silver Spring) 15:
21. Hertz RP, Unger AN, Cornell JA, Saunders E (2005) Racial disparities in
hypertension prevalence, awareness, and management. Arch Intern Med 165:
22. Ashaye MO, Giles WH (2003) Hypertension in Blacks: a literature review. Ethn
Dis 13: 456–462.
23. Frieden TR (2011) Forward: CDC Health Disparities and Inequalities Report -
United States, 2011. MMWR Surveill Summ 60 Suppl. pp 1–2.
24. Samadi AR, Mayberry RM, Zaidi AA, Pleasant JC, McGhee N Jr., et al. (1996)
Maternal hypertension and associated pregnancy complications among African-
American and other women in the United States. Obstet Gynecol 87: 557–563.
25. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, et al. (2010)
Births: final data for 2007. Natl Vital Stat Rep 58: 1–85.
26. Kallen BA, Otterblad Olausson P (2003) Maternal drug use in early pregnancy
and infant cardiovascular defect. Reprod Toxicol 17: 255–261.
27. Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, et al. (2006)
Major congenital malformations after first-trimester exposure to ACE inhibitors.
N Engl J Med 354: 2443–2451.
28. Lennestal R, Otterblad Olausson P, Kallen B (2009) Maternal use of
antihypertensive drugs in early pregnancy and delivery outcome, notably the
presence of congenital heart defects in the infants. Eur J Clin Pharmacol 65:
29. Caton AR, Bell EM, Druschel CM, Werler MM, Lin AE, et al. (2009)
Antihypertensive medication use during pregnancy and the risk of cardiovas-
cular malformations. Hypertension 54: 63–70.
30. Nakhai-Pour HR, Rey E, Berard A (2010) Antihypertensive medication use
during pregnancy and the risk of major congenital malformations or small-for-
gestational-age newborns. Birth Defects Res B Dev Reprod Toxicol 89:
31. Davis RL, Eastman D, McPhillips H, Raebel MA, Andrade SE, et al. (2011)
Risks of congenital malformations and perinatal events among infants exposed to
calcium channel and beta-blockers during pregnancy. Pharmacoepidemiol Drug
Saf 20: 138–145.
32. Li DK, Yang C, Andrade S, Tavares V, Ferber JR (2011) Maternal exposure to
angiotensin converting enzyme inhibitors in the first trimester and risk of
malformations in offspring: a retrospective cohort study. BMJ 343: d5931.
33. Podymow T, August P (2008) Update on the use of antihypertensive drugs in
pregnancy. Hypertension 51: 960–969.
34. Finer LB, Henshaw SK (2006) Disparities in rates of unintended pregnancy in
the United States, 1994 and 2001. Perspect Sex Reprod Health 38: 90–96.
35. Beilin LJ, Puddey IB (2006) Alcohol and hypertension: an update. Hypertension
36. Lim KG, Isles CG, Hodsman GP, Lever AF, Robertson JW (1987) Malignant
hypertension in women of childbearing age and its relation to the contraceptive
pill. Br Med J (Clin Res Ed) 294: 1057–1059.
37. Chasan-Taber L, Willett WC, Manson JE, Spiegelman D, Hunter DJ, et al.
(1996) Prospective study of oral contraceptives and hypertension among women
in the United States. Circulation 94: 483–489.
38. Woods JW (1988) Oral contraceptives and hypertension. Hypertension 11:
39. Halperin RO, Gaziano JM, Sesso HD (2008) Smoking and the risk of incident
hypertension in middle-aged and older men. Am J Hypertens 21: 148–152.
Chronic Hypertension in Women of Reproductive Age
PLoS ONE | www.plosone.org7 April 2012 | Volume 7 | Issue 4 | e36171