282: Risk of stillbirth after antepartum hospitalization for gestational hypertension or preeclampsia

Abstract

Hypertensive diseases of pregnancy (HDP), including gestational hypertension and preeclampsia, are associated with increased risk for stillbirth. Patients with HDP may be admitted antenatally and then discharged with increased surveillance. For women with HDP at delivery, we sought to determine if preceding antenatal admission for HDP was associated with increased risk of stillbirth. This study used the 2010-2014 Nationwide Readmission Database. Deliveries hospitalizations with HDP occurring October to December each year were analyzed. We defined an antenatal admission with HDP as the primary diagnosis occurred within 9 months preceding each delivery. Our primary outcomes were stillbirth and stillbirth with placental abruption during delivery hospitalization. Subgroup analyses were conducted among patients admitted antenatally for HDP with primary predictors of number of admissions and cumulative antepartum length of stay. Log linear regression models including demographic and hospital factors were fit to characterize the adjusted effect of antepartum HDP admission on stillbirth. 3.9 million deliveries occurred in this time period, with 319,105 (8.2%) HDP deliveries occurred in this time period, (overall 8.2%), 0.8% with stillbirth (n=2,464), and 0.2% (n=553) with stillbirth and abruption. 3.2% (n=10,297) required antepartum admission for HDP. Among women with HDP, antepartum HDP admission was associated with higher risks of stillbirth and stillbirth/abruption (1.2% vs. 0.8%, 0.3% vs. 0.2%, respectively, p<0.01). In adjusted analysis, patients with HDP antepartum admissions were at increased risk of stillbirth/abruption (RR=1.52, 95% CI: 1.04, 2.21) (Table 1) and of stillbirth alone (RR=1.32, 95% CI: 1.10, 1.58). Among those with antepartum HDP admissions, >1 admission was associated with 3-fold higher risk of stillbirth/abruption (RR=3.39, 95% CI: 1.58, 7.28) (Table 2). Antepartum admission for HDP is a significant risk factor for stillbirth. Risk for stillbirth/abruption rose with number of antenatal admissions. Admission may be a proxy for disease activity; these high-risk patients require specialized care. For patients with an antenatal HDP diagnosis managed on an outpatient basis, close surveillance with regular fetal testing is indicated. Further research is warranted to identify optimal management strategies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)