| Description: |
Introduction: Maternal chronic hypertension (MCH), defined as chronic hypertension affecting pregnancy, has increased rapidly in prevalence among civilians. Although women Veterans have more risk factors for chronic hypertension than civilian women, little is known about MCH in this group. Methods: This descriptive, observational study used data from the Surgical Treatment Outcomes for Patients with Psychiatric Disorders (STOPP) project, which includes 11 million Veterans with and without mental illness using the Veterans Health Administration. Women Veterans aged 18-60 years at time of pregnancy identification were included if they had chronic hypertension before pregnancy in fiscal years 2010-2019. We identified chronic hypertension and first pregnancy based on diagnosis codes and defined uncontrolled blood pressure as ≥140/90 mm Hg on at least one measurement in the year prior to pregnancy. For antihypertensive medications (AHMs) that are recommended or not recommended for use in pregnancy, multivariable logistic regression was used to assess the association of comorbidities with (a) non-recommended AHM received 0-6 months before pregnancy, (b) non-recommended AHM received during pregnancy (c) recommended AHM received 0-6 months before pregnancy, and (d) recommended AHM received during pregnancy. Results: In total, 9.9% (4,302/43,251) of women Veterans who became pregnant had MCH, with mean age 37.0 years (SD=8.2). Among those with MCH who met inclusion criteria, 62% (N=1,839) had uncontrolled blood pressure in the year prior to pregnancy. Furthermore, 20% (N=611) received a non-recommended AHM 0-6 months before pregnancy, 19% (N=564) received a non-recommended AHM during pregnancy, 26% (N=784) received a recommended AHM 0-6 months before pregnancy, and 33% (N=995) received a recommended AHM during pregnancy. Chronic kidney disease (OR 3.0, 95% CI: 1.6-5.6) and diabetes (OR 2.5, 95% CI:1.9-3.2) were most strongly associated with use of a non-recommended AHM during pregnancy. Conclusion: Interventions are ... |