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Pulmonary Hypertension During Pregnancy in New York State, 2003–2014

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Abstract

Objectives This study examined the prevalence and temporal trends in (a) pulmonary hypertension (PH) during pregnancy and (b) mortality and morbidity during pregnancy with and without PH. Methods This was a retrospective observational study of the 2003–2014 New York State Inpatient Database. PH was categorized as primary or secondary and pregnancy as loss or termination of pregnancy, preterm birth, or term birth. The Centers for Disease Control and Prevention definition of maternal morbidity was used, including 17 diagnoses and 5 procedures. Changes were assessed using Cochran-Armitage trend tests. Results Of 2,940,868 pregnancy-related discharges, 746 indicated a diagnosis of PH (25/100,000; 95% CI 24–27). PH was secondary in 677/746 (91%) discharges and 488/746 were term births (65%). Prevalence of secondary PH increased from 17 to 30/100,000 between 2003– 2004 and 2013–2014 (+ 69%; P < 0.001), with an increase in the prevalence of heart valve disease, obesity, and systemic hypertension. Primary PH decreased 81% (P = 0.002). Term-birth PH discharges increased from 13 to 22/100,000 between 2003–2004 and 2013–2014 (+ 66%; P = 0.003), without change in preterm births and loss or termination of pregnancies. No change in morbidity in PH discharges was observed between 2003–2004 and 2013–2014, contrasting with a 64% increase in discharges without PH. Conclusions for Practice Prevalence of secondary PH during pregnancy markedly increased since 2003, underscoring the importance of screening for PH, especially in women with heart valve disease, obesity, or systemic hypertension.

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Abbreviations

AHA:

American Hospital Association

CDC:

Centers for Disease Control and Prevention

CI:

Confidence interval

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

OR:

Odds ratio

PH:

Pulmonary hypertension

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA

    Jean Guglielminotti, Ruth Landau & Guohua Li

  2. INSERM, UMR 1137, IAME, 16 rue Henri Huchard, 75018, Paris, France

    Jean Guglielminotti

  3. Département d’Anesthésie-Réanimation, APHP, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75 877, Paris Cedex 18, France

    Jean Guglielminotti

  4. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, USA

    Alexander M. Friedman

  5. Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA

    Guohua Li

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  1. Jean Guglielminotti
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Guglielminotti, J., Landau, R., Friedman, A.M. et al. Pulmonary Hypertension During Pregnancy in New York State, 2003–2014. Matern Child Health J 23, 277–284 (2019). https://doi.org/10.1007/s10995-018-2652-5

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