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Poster Session 3

Category: Hypertension

Poster Session 3

(859) Factors that account for cesarean delivery in the chronic hypertension population

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Marcia Des Jardin, MD

Maternal Fetal Medicine & Medical Genetics Fellow
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States

Coauthor(s)

JL

Justin M. Leach, PhD

Assistant Professor of Biostatistics
Center for Research in Women’s Health, University of Alabama at Birmingham
Birmingham, Alabama, United States

Objective:

The cesarean delivery rate in patients with chronic hypertension (CHTN) is high (up to 50%). We aim to identify risk factors for cesarean delivery in patients with CHTN to explain the increased rate.

Study Design:

This is a secondary analysis of CHAP, a multicenter treatment RCT of patients with mild CHTN enrolled prior to 23 weeks’ gestation. Logistic regression was performed for both unadjusted and multivariable models of cesarean section using predefined characteristics (Table). The multivariable models were (1) full model, (2) full model excluding labor type. The area under the ROC curve was used to evaluate multivariable models for predictive performance.

Results:

Of 2292 patients who were included, 1174 had a cesarean delivery and 1118 had a successful vaginal delivery, for a cesarean rate of 49%. In the full model, increasing BMI, pregestational diabetes, preeclampsia, nulliparity, no prior preeclampsia, and “no labor” were associated with increased CD. When excluding labor type, nulliparity and no prior preeclampsia were similarly associated, but preeclampsia and prior preeclampsia were not statistically significant with cesarean delivery; additionally increasing age, and decreasing gestational age were associated with cesarean delivery.

Predictive performance as estimated by AUC was 0.87 (95% CI: [0.86, 0.89]) for the full model, 0.68 (95%CI: [0.66, 0.70]) excluding labor type (Figure 1).

Conclusion:

Risk factors for CD in a CHTN cohort are similar to reported risk factors for all US patients. In a model that includes all labor types (none, spontaneous or induced labor), a prediction model for cesarean deliveries was superior to one that excluded labor or evaluated baseline characteristics only.