525 Maternal morbidity and pregnancy outcomes in teens vs. adults with hypertensive disorders of pregnancy

Abstract

Teens <20 years old carry a 2.6x increased risk of preeclampsia (PREE) compared to older gravidas, but whether they have more severe disease is unclear. We sought to compare rates of hypertensive-related morbidity, abnormal labs, intrapartum BP, and delivery gestational age between teen and older gravidas with hypertensive disorders of pregnancy. This was a retrospective cohort study of women with a diagnosis of gestational HTN, PREE, or eclampsia carrying a singleton non-anomalous pregnancy in a University-based healthcare system, 2014-2020. The primary outcome was major maternal HTN-related morbidity (defined as ≥ 1 of the following: lab criteria for HELLP, Cr ≥1.0, seizure, stroke, MI, heart failure, and pulmonary edema), regardless of BP. Secondary outcomes were delivery GA, SGA < 10%, SGA < 3%, individual lab parameters, and intrapartum BP parameters. Data were analyzed with chi-square, t-test, and logistic regression. 8,659 women met inclusion criteria; 395 (4.6%) were teens < 20yo at EDC. HTN morbidity occurred in 9.6% of all women. Teens were “healthier” at baseline with lower pre-pregnancy BMI, lower rates of diabetes, CHTN, and smoking during pregnancy (Table 1). Teens also delivered later and were less likely to deliver preterm. However, SGA neonates < 10% and < 3% were more commonly delivered to teens. In addition, teens were less likely to have elevated systolic ( >140 and > 160) and diastolic ( > 90) initial BP readings intrapartum. Despite this, rates of HTN-related morbidity were similar in teens and adults (8.4% vs. 9.6%, p=0.40). In multivariable models, after controlling for Black race, chronic hypertension, diabetes mellitus, and smoking during pregnancy, teen gravidas did not have a higher risk of HTN-related morbidity (aOR 0.92, 95% CI 0.64-1.33). Though teens with hypertensive disorders of pregnancy are “healthier” at the onset of pregnancy than older gravidas, serious HTN-related morbidity is common and occurs at similar rates among teens compared to adults.