Abstract
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 coronavirus
disease 2019 (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 with the prepandemic 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 International Classification of Disease, Tenth Revision 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 HDP during the COVID era (9.0 vs. 6.9%;
p < 0.01), which was significant even when controlling for patient parity (odds ratio
= 1.41, 95% confidence interval: 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.
Key Points
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Rates of HDP increased during the COVID-19 pandemic.
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There was no change in the proportion of severe HDP.
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HDP-related maternal/neonatal morbidity was unchanged.
Keywords
COVID-19 pandemic - hypertensive disorders of pregnancy - maternal morbidity - telemedicine
