Log in to MyACC
Pre-Pregnancy Hypertension Among Women in Rural and Urban Areas
Quick Takes
- The prevalence of pre-pregnancy hypertension in the United States has nearly doubled in the past decade, and the trend appears to be increasing.
- Women in rural communities have higher rates of pre-pregnancy hypertension.
- Measures to address pre-conception screening for hypertension and management during and after pregnancy are needed to improve maternal health.
Study Questions:
What are the trends in maternal pre-pregnancy hypertension among women in rural and urban areas in the United States?
Methods:
The Centers for Disease Control and Prevention (CDC) Natality Database (2007-2018) was used to study maternal data from all live births to women ages 15-44 years. Pre-pregnancy hypertension was calculated per 1,000 births overall and by urbanization status, with subgroup analysis in 5-year age categories. The annual percentage change was calculated using Joinpoint Regression and rate ratios (RR [95% confidence interval]) to compare annual rates in urban and rural areas.
Results:
A total of 47,949,381 live births were included. Overall, the prevalence of pre-pregnancy hypertension increased from 10.9 per 1,000 live births in 2007 to 20.5 per 1,000 live births in 2018. The prevalence increased among both rural (13.7 to 23.7) and urban (10.5 to 20.0) women. Absolute rates were lower in younger women, but all age groups experienced similar increases in pre-pregnancy hypertension during the study period.
Conclusions:
Pre-pregnancy hypertension has nearly doubled in the past decade, with persistently higher rates in rural areas.
Perspective:
Significant rural-urban disparities in maternal morbidity and mortality exist in the United States. Pre-pregnancy hypertension is a risk factor for several adverse pregnancy outcomes and is also associated with increased risk of long-term cardiovascular disease. This study demonstrates higher rates of pre-pregnancy hypertension among rural women as compared with urban women, and this difference has persisted over the past decade. The American Heart Association and American College of Obstetricians and Gynecologists have advocated for increasing the number of rural physicians, expanding telehealth, widening insurance coverage, and identifying other potential barriers. As this study demonstrates, the prevalence of pre-pregnancy hypertension continues to rise; therefore, public health measures, awareness, and access to care are all essential for improving maternal and fetal outcomes.
Clinical Topics: Cardiovascular Care Team, Prevention, Vascular Medicine, Hypertension
Keywords: Healthcare Disparities, Health Services Accessibility, Hypertension, Live Birth, Maternal Mortality, Pregnancy, Pregnancy Outcome, Prehypertension, Prenatal Care, Primary Prevention, Public Health, Risk Factors, Rural Population, Telemedicine, Urbanization, AHA20, AHA Annual Scientific Sessions
< Back to Listings
