Increased rates of hypertensive disorders of pregnancy during the COVID-19 pandemic.

OBJECTIVE: Hypertensive disorders of pregnancy (HDP) are common complications associated with severe maternal and neonatal morbidity. One goal of prenatal care, especially at term, is to screen for HDP. As treatment of HDP centers on delivery when appropriate, timely diagnosis is crucial. We postulated that reduced in-person visits during the COVID-19 pandemic may have resulted in delayed diagnosis of HDP with concomitant higher rates of maternal morbidity. We sought to investigate the prevalence of HDP during the COVID-19 pandemic, as well as median gestational age at time of delivery as compared to the pre-pandemic median.

STUDY DESIGN: This was a retrospective cohort analysis comparing singleton deliveries at four large volume hospitals during the COVID-19 pandemic (April - July 2020 during a statewide "stay-at-home" order) to those in a pre-COVID era (April - July 2019). Deliveries complicated by HDP were identified by ICD-10 codes. Rates of HDP and markers of severe disease were the primary outcomes compared between the groups; multivariate regression was used to calculate the odds ratio of severe disease among women with any diagnosis of HDP.

RESULTS: The cohort included 9,974 deliveries: 5,011 in 2020 and 4,963 in 2019. Patient characteristics (age, body mass index, race, ethnicity, and insurance type) did not differ significantly between the groups. There was an increase in hypertensive disorders of pregnancy during the COVID era (9.0% vs. 6.9%; p<0.01), which was significant even when controlling for patient parity (OR 1.41, 95% CI 1.20-1.66). Among women with HDP, gestational age at delivery did not differ between the cohorts, nor did the proportion of patients with severe disease.

CONCLUSION: We found a statistically significant increase in the rate of HDP during the COVID-19 pandemic. However, there was no change in the proportion of severe disease, suggesting that this increase did not significantly impact clinical morbidity.