Disparities in hypertensive disorders of pregnancy and severe maternal morbidity: Evidence from a statewide birth cohort.
- 1University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA.
- 2Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of Wisconsin Madison School of Medicine and Public Health Madison Wisconsin USA.
- 3Department of Population Health Sciences Department of Biostatistics and Medical Informatics University of Wisconsin Madison School of Medicine and Public Health Madison Wisconsin USA.
Abstract
Objective
Hypertensive disorders of pregnancy (HDP) complicate 15% of pregnancies nationally and are a major contributor to severe maternal morbidity (SMM). We aimed to characterize temporal trends and demographic disparities in HDP incidence and evaluate the association between HDP and SMM in a statewide cohort.Methods
This study is a descriptive and regression-based analysis of a retrospective cohort of Wisconsin births from 2017 to 2023. Data were obtained from the Wisconsin Hospital Association (WHA). Subtypes of HDP were identified using ICD-10 codes. Incidence rates of HDP per 10,000 births and average annual percent changes (AAPC) were estimated using Poisson regression and examined across demographic variables. Outcomes measured included SMM incidence, AAPCs, and SMM indicators by HDP.Results
Among 388,250 pregnancies, the incidence of nearly all HDP subtypes rose from 2017 to 2023. Severe pre-eclampsia had the highest AAPC (11.8%; 95% confidence interval [CI], 10.6%-13.0%). HDP incidence was highest in urban areas, though the AAPC in preeclampsia was greater in rural areas (8.7%; 95% CI, 7.1%-10.3%; p = 0.004). Black patients experienced higher incidences of HDP, with significant differences in AAPC for HDP overall, chronic hypertension, and severe preeclampsia (p < 0.001). Patients with HDP had higher SMM rates compared to those without, though the AAPC in SMM did not differ by HDP status.Conclusion
These findings highlight a growing burden of HDP in Wisconsin, with an increase in severe preeclampsia incidence and disparities by geography and race. Targeted interventions in rural areas and for Black patients are needed to improve disparities in HDP incidence and reduce SMM across Wisconsin.
Related
- County-Level Structural Racism and Racial Disparities in Hypertensive Disorders of Pregnancy in Georgia
- Hypertension in People with Multiple Sclerosis: Epidemiology, Mechanisms, Hypertensive Disorders of Pregnancy, and Clinical Implications.
- Causal effects of physical activity and sedentary behaviors on hypertensive disorders of pregnancy: a two-sample Mendelian randomization study
- Pragmatic trial of a multilevel community-centred intervention to reduce pregnancy-related and associated morbidity and mortality and disparities: a study protocol
- A systematic review of the influence of hypertensive disorders of pregnancy on the mental health of expectant mothers in Nigeria
BibTeX
@article{solberg2026disparities,
title = {{Disparities in hypertensive disorders of pregnancy and severe maternal morbidity: Evidence from a statewide birth cohort.}},
author = {Alyssa Solberg and Kara Hoppe and Ronald Gangnon and Jacqueline M Powell},
journal = {Pregnancy (Hoboken, N.J.)},
year = {2026},
month = oct,
doi = {10.1002/pmf2.70493},
url = {https://europepmc.org/article/MED/42927240},
note = {CC BY},
}
RIS
TY - JOUR
TI - Disparities in hypertensive disorders of pregnancy and severe maternal morbidity: Evidence from a statewide birth cohort.
AU - Alyssa Solberg
AU - Kara Hoppe
AU - Ronald Gangnon
AU - Jacqueline M Powell
PY - 2026
DA - 2026/10/24
JO - Pregnancy (Hoboken, N.J.)
DO - 10.1002/pmf2.70493
UR - https://europepmc.org/article/MED/42927240
AB - Objective Hypertensive disorders of pregnancy (HDP) complicate 15% of pregnancies nationally and are a major contributor to severe maternal morbidity (SMM). We aimed to characterize temporal trends and demographic disparities in HDP incidence and evaluate the association between HDP and SMM in a statewide cohort.Methods This study is a descriptive and regression-based analysis of a retrospective cohort of Wisconsin births from 2017 to 2023. Data were obtained from the Wisconsin Hospital Association (WHA). Subtypes of HDP were identified using ICD-10 codes. Incidence rates of HDP per 10,000 births and average annual percent changes (AAPC) were estimated using Poisson regression and examined across demographic variables. Outcomes measured included SMM incidence, AAPCs, and SMM indicators by HDP.Results Among 388,250 pregnancies, the incidence of nearly all HDP subtypes rose from 2017 to 2023. Severe pre-eclampsia had the highest AAPC (11.8%; 95% confidence interval [CI], 10.6%-13.0%). HDP incidence was highest in urban areas, though the AAPC in preeclampsia was greater in rural areas (8.7%; 95% CI, 7.1%-10.3%; p = 0.004). Black patients experienced higher incidences of HDP, with significant differences in AAPC for HDP overall, chronic hypertension, and severe preeclampsia (p < 0.001). Patients with HDP had higher SMM rates compared to those without, though the AAPC in SMM did not differ by HDP status.Conclusion These findings highlight a growing burden of HDP in Wisconsin, with an increase in severe preeclampsia incidence and disparities by geography and race. Targeted interventions in rural areas and for Black patients are needed to improve disparities in HDP incidence and reduce SMM across Wisconsin.
SN - 2997-9684
ER -