382 - Association of COVID-19 and Hypertensive Disorders in Pregnancy in the United States: A Time Trends and Interrupted Time Series Analysis.

Publication Number: 382.3632

Ramesh Vidavalur, Weill Cornell Medicine, Ithaca, NY, United States; Srisatish Devapatla, Cayuga Medical Center, Ithaca, NY, United States; Nitin N. Wadhwa, Norton Children's Neonatology, University of Louisville Department of Pediatrics, LOUISVILLE, KY, United States

Background: Studies have reported an increased incidence of preeclampsia and HELLP syndrome in COVID-19-infected pregnant mothers. However, recent evidence suggests no significant difference in chronic hypertension, gestational hypertension, or rates of preeclampsia and eclampsia between vaccinated and unvaccinated cohorts (Piekos et al., 2023).

Objective: To analyze and assess trends in hypertensive disorders during pregnancy before and after the onset of the COVID-19 pandemic in the United States.

Design/Methods: Using retrospective linked birth cohort and vital records data (2016–2023) from the CDC WONDER database, we extracted and analyzed natality data. The primary outcome was the prevalence of pre-pregnancy hypertension, gestational hypertension, and eclampsia per 1,000 live births, along with changes in these rates over time. We employed segmented linear regression using the Joinpoint program (version 5.2.0, National Cancer Institute, USA) to assess annual percent changes (APCs) and to identify significant inflection points, with statistical significance set at p<.05. Additionally, we used an interrupted time series (ITS) design to examine slope and step changes before and after the COVID-19 pandemic (2021).

Results: Over the 8-year period, gestational hypertension rates significantly increased, with an APC of 8.8% (95% CI: 8.5–10.2; p<.001) from 2016 to 2021, and an APC of 4.7% (95% CI: 2.7–6.8; p<.001) since 2021. The prevalence of eclampsia decreased at an APC of -6.6% (95% CI: -12.6% to -0.5%; p=0.04) since 2021, while pre-pregnancy hypertension consistently rose with an APC of 9.0% (95% CI: 8.4–9.6; p<.001). ITS analysis revealed that gestational hypertension showed a notable step change (p=0.05) and slope change (p=0.04) after the onset of COVID-19, with slower rate increases since the pandemic. No significant step or slope changes were observed for eclampsia or pre-pregnancy hypertension.

Conclusion(s): The results suggest the COVID-19 pandemic has had varying impacts on different hypertensive conditions during pregnancy. Gestational hypertension was most affected, showing significant increases in both step and slope changes, while eclampsia exhibited non-significant changes. Over the past 8 years, gestational hypertension prevalence increased from 6% to 10% among pregnant women. Future studies are needed to explore differences in outcomes between vaccinated and unvaccinated pregnant women during the post-COVID period.

Figure 1.
Joinpoint Trend Analysis of Prevalence of Hypertensive Disorders in Pregnancy, 2016-2021.

Figure 2
Interrupted Time Series Analysis of Hypertensive Disorders in Pregnancy, 2016-2021.

Figure 1.
Joinpoint Trend Analysis of Prevalence of Hypertensive Disorders in Pregnancy, 2016-2021.

Figure 2
Interrupted Time Series Analysis of Hypertensive Disorders in Pregnancy, 2016-2021.