Preeclampsia with or without Chronic Hypertension: Differences and Outcomes [32B]. (May 2018)

• Record Type: Journal Article
• Authors: Rincon, Monica; Beeraka, Sridivya Spurthi; Burwick, Richard M.
• Is Part Of: Obstetrics and gynecology. Volume 131(2018)Supplement 1
• Publication Date: 2018-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000532934.58097.b3
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: It is unclear if women with chronic hypertension (CHTN) and superimposed preeclampsia (siPE) have more severe disease than women with preeclampsia (PE) without CHTN. We sought to compare disease features and outcomes in these groups. METHODS: Retrospective cohort study (Oct'13 - May'17) at a single institution, among subjects with hypertensive disease in pregnancy, delivered ≥23 weeks gestation, who were screened using ICD-9 and ICD-10 codes with subsequent chart validation. Subjects were divided: 1) CHTN; 2) Gestational hypertension (GHTN); 3) PE and, 4) PE with severe features (PE-SF). Those with siPE were placed in Group 3 or 4, as determined by labs or symptom criteria. Differences were assessed by Chi-square, Fisher exact or Student t -test. RESULTS: Among 1, 188 pregnancies with a hypertensive disorder, 626 developed PE; of which 140 (22.4%) had siPE. CHTN was more common in PE-SF than PE without SF (29.3% vs. 15.2%, P<.001). Compared to women with PE, those with siPE were more likely to have severe headache (30.9 vs. 18.5%, p=0.002) and pulmonary edema (5.7 vs. 1.7%, P .007). Other severe features of PE were similar regardless of CHTN including thrombocytopenia, elevated liver enzymes, kidney injury, and eclampsia. Those with CHTN and siPE were more likely to have preterm neonates (53.0 vs. 24.6%) P<.001) with respiratory distress syndrome (RDS) (30.3 vs. 13.5%, P<.001). CONCLUSION: Women with CHTN and siPE have more severe disease than women with PE alone. Notably, siPE is associated with more headache, pulmonary edema, preterm delivery, and RDS