Abstract
Introduction: Epidemiologic studies of hypertension in pregnancy traditionally rely on diagnosis codes to identify cases. Electronic medical records make it possible to incorporate measured blood pressures (BPs) into case definitions. Our aim was to examine hypertension trends in pregnancy comparing two methodologies: 1) Traditional and 2) BP-Augmented definitions. Methods: All pregnancies between 2009 -2014 were identified within an integrated healthcare delivery system. Hypertension case definitions were applied: 1) A Traditional definition based solely on delivery discharge diagnosis codes, and 2) A BP-Augmented definition using the following criteria during pregnancy: (a) two elevated outpatient BP measures (≥ 140/90 mmHg) on separate days, within 30 days of each other; (b) an antihypertensive medication fill plus a hypertension diagnosis code during pregnancy; or (c) a hospital discharge diagnosis of preeclampsia. Descriptive statistics were used to compare the two case definitions and temporal trends. Results: Of the 145,739 pregnancies, 13,637 [9.4%] met the Traditional definition and 14,225 [9.8%] met the BP-Augmented case definition (10,809 [7.4%] met both case definitions). There was a slight increase in hypertension prevalence over time based on both case definitions (figure). With the BP-Augmented definition, the prevalence increased from 9.5% of live births in 2009 to 9.8% of live births in 2014 (3% increase). For the traditional definition, the prevalence increased from 9.2% to 10.2% from 2009 to 2014 (11% increase). Conclusion: Results suggest that the prevalence of hypertension in pregnancy increased slightly from 2009-2014 with both case definitions. The two methods identified somewhat different populations with only 10,809 meeting both case definitions. Additional work is needed to validate the BP-Augmented definition’s predictive power to identify clinically important maternal and fetal outcomes.
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