Abstract 042: Trends In Hypertensive Disorders Of Pregnancy Among Nulliparous Individuals With Singleton Live Births In The United States: An Age-period-cohort Analysis Between 1995-2019

• Published in: Circulation (New York, N.Y.) Vol. 145; no. Suppl_1
• Main Authors: Cameron, Natalie A, Petito, Lucia, Shah, Nilay, Perak, Amanda M, Catov, Janet M, Bello, Natalie A, CAPEWELL, Simon, Oflaherty, Martin E, Lloyd-jones, Don M, Greenland, Philip, GROBMAN, William, Khan, Sadiya
• Format: Journal Article
• Language: English
• Published: 01-03-2022
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.145.suppl_1.042

Abstract only
Introduction:
Incidence of hypertensive disorders of pregnancy (HDP) has increased concurrently with maternal age at first birth. To better understand the contributions of age, delivery year (period), and maternal birth year (birth cohort) to HDP rates, we performed an age-period-cohort analysis.
Methods:
We included data from the National Center for Health Statistics for nulliparous individuals without pre-pregnancy hypertension who were 15-44 years with singleton live births from 1995-2019. We defined HDP as gestational hypertension, preeclampsia or eclampsia. We determined age effects by calculating HDP incidence adjusted separately for period and cohort in each 5-year age group. Period and cohort effects were quantified as rate ratios (RR) comparing age-adjusted HDP incidence to the median period (2005-2009) and cohort (1980-1984), respectively. Age, period, and cohort effects were summarized as the age-standardized estimated annual percent change (EAPC) in HDP rates adjusted for cohort and stratified by self-reported maternal race and ethnicity group (Hispanic, non-Hispanic American Indian/Alaskan Native [AIAN], non-Hispanic Asian-Pacific Islander [API], non-Hispanic Black [NHB], non-Hispanic White [NHW]).
Results:
Of 38,141,561 individuals included, 0.8% were AIAN, 6.5% API, 20.2% Hispanic, 13.9% NHB, and 57.8% NHW. Mean maternal age increased from 1995-2019 (24.5-26.9). Age, period and cohort were each significantly associated with HDP rates overall and in each race and ethnicity group. Incidence was higher with older maternal age. Age-standardized incidence increased from 1995-2019 (EAPC 2.1%/year [2.1-2.2]). RR of HDP in pregnant individuals born 2000-2004 versus 1980-1984 was 1.5 (1.4-1.5). Differences in RRs among racial and ethnic groups were observed with the largest cohort effects among API and NHB individuals born 2000-2004. (
FIGURE
).
Conclusions:
More recent generations have experienced substantially higher rates of HDP, even with adjustment for maternal age and delivery year.