279: Antenatal hypertension toolkit utilization improves outcomes of women at risk for hypertensive disorders of pregnancy

Abstract

To determine if an antenatal hypertension toolkit improves management and outcomes of women at risk for hypertensive disorders of pregnancy. A retrospective cohort study was performed on pregnant women presenting for routine care at a university hospital from 2017-2018. Included in the study were women with a confirmed intrauterine pregnancy with risk factors for hypertensive disorders of pregnancy. Excluded were any cases of fetal loss, anomalies or terminations. Women were risk stratified into moderate risk or high risk per an office based hypertension toolkit. Women in the high risk group included those with a history of preeclamspia, multiple gestation, chronic hypertension, pregestational diabetes, renal disease, and/or autoimmune disease. Women in the moderate risk group included those who were nulliparous, obese, had a family history of preeclampsia, advanced maternal age, and/or had a pregnancy interval of more than 10 years. Per the toolkit, low dose aspirin administration prior to 16 weeks was proposed for those with one risk factor in the high risk group or 2+ risk factors in the moderate risk group. Adherence to the toolkit's recommendation and incidence of hypertensive disorders of pregnancy was collected and compared. Chi square and fisher’s exact tests were used as appropriate. A p value of < 0.05 was deemed statistically significant. A total 94 women were included in the study. The incidence of hypertensive disorders of pregnancy in this cohort was 30.9%. Maternal characteristics associated with missed intervention opportunities included nulliparity, carrying a multiple gestation pregnancy and having pregestational diabetes, Table 1. Adherence to the antenatal toolkit recommendations were associated with a significant reduction in the incidence of hypertensive disorders of pregnancy (20.0% vs. 43.2%, p=0.01), Table 2. Utilization of an antenatal hypertension toolkit not only aids with the identification and management of women at risk for hypertensive disorders of pregnancy, but can also decrease the incidence of disease onset and recurrence.View Large Image Figure ViewerDownload Hi-res image Download (PPT)