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Understanding Maternal Hypertension and Pre-eclampsia to Improve Outcomes

Research September 29, 2023

Elevance Health researchers conducted an analysis on hypertensive (high blood pressure) disorders, which affect 1 in 10 pregnancies in the United States. The study evaluated risk factors associated with progression of hypertensive disorder severity during pregnancy. It also evaluated the association of hypertensive disorders with outcomes such as pre-term delivery, low birth weight, stillbirth, c-section, Neonatal Intensive Care Unit (NICU) use, and maternal readmissions.

Findings: The characteristics most associated with a progression from hypertension to pre-eclampsia, a life-threatening hypertensive condition during pregnancy, were being obese or overweight and having pre-eclampsia during a prior pregnancy.

Women with pre-eclampsia had triple the risk of pre-term delivery and a baby requiring NICU use when compared with people with no hypertension.

One encouraging finding was in people who developed high blood pressure after 20 weeks gestation (called gestational hypertension) that did not progress to pre-eclampsia. This group’s rates of many adverse outcomes (such as preterm birth) were statistically similar to those with no hypertension at all. This was an encouraging sign that when pre-eclampsia is prevented, people with gestational hypertension are likely to have favorable birth outcomes.

What’s Next: The findings from the maternal health study supported the creation of a digital platform for Maternity Education and Care Management in partnership with Elevance Health’s subsidiary Carelon Israel. The clinical leadership team developed programs to support member-driven and nurse-driven preventive care focused on reducing risk of progression of disease.

Methodology: This analysis used Medicaid claims data to identify women with a range of hypertensive disorders during pregnancy (including gestational hypertension, chronic hypertension, pre-eclampsia, and superimposed pre-eclampsia), matched to cohorts of women without hypertension during pregnancy. Regression models were used to compare maternal and neonatal outcomes for the cohorts with and without hypertensive disorders. Additionally, a stepwise logistic regression model was used to determine characteristics associated with progression of gestational hypertension to pre-eclampsia or progression of chronic (preexisting) hypertension to superimposed pre-eclampsia.

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