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Poster Session 2

Category: Epidemiology

Poster Session 2

(449) Severe maternal morbidity and mortality among patients with hypertensive disorders of pregnancy

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

BH

Brittany Hood, MD

Physician Fellow
University of Kentucky
University of Kentucky/Lexington, Kentucky, United States

Coauthor(s)

Elizabeth L. Mirsky, BS, MD (she/her/hers)

Maternal Fetal Medicine Fellow
University of Kentucky
University of Kentucky/Lexington, Kentucky, United States
ED

Emily A. DeFranco, DO, MS

University of Kentucky
University of Kentucky/Lexington, Kentucky, United States

Objective:
Hypertensive disorders of pregnancy (HDP) are a leading cause of severe maternal morbidity (SMM) and mortality in the US. Rates are rising and are higher than other industrialized nations. Although the association between HDP and SMM is established, there is a paucity of data quantifying risk by severity of the subtype of HDP, which we aimed to assess.

Study Design:
Population-based retrospective cohort study using US delivery data from the National Inpatient Sample database from 2016-2022. The 10th edition International Classification of Diagnoses codes were used to identify delivery admissions, diagnosis of HDP and indicators of SMM, defined by Centers for Disease Control and Prevention criteria. Generalized linear models estimated crude and adjusted relative risks (aRRs) and 95% confidence intervals for SMM, mortality and individual SMM contributors among HDP subtypes using Stata.

Results:
We identified 4,992,996 hospital admissions associated with a birth, of which, 760,683 (15.2%) had HDP. All subgroups were associated with a modest increase in SMM, however there was a significant risk increase among patients with preeclampsia (PE) without severe features (aRR [95%CI] 2.35 [2.28-2.42]), PE with severe features (4.71 [4.62-4.81]), chronic hypertension (CHTN) with superimposed preeclampsia (SIP) (3.69 [3.57-3.82]), and HELLP (12.41 [11.98-12.86]) even after adjustment for maternal age, race, pregestational diabetes, and low income. Maternal mortality risk was highest in patients with CHTN (2.57 [1.66-3.99]), CHTN with SIP (3.54 [2.06-6.07]), and HELLP (19.77 [12.28-31.83]) when adjusted for maternal race.

Conclusion:
Preeclampsia is associated with a 2.3- to 4.7-fold increase in SMM, while HELLP confers a 12.4-fold increase. Maternal mortality risk is elevated with CHTN and rises nearly 20-fold with HELLP. Sociodemographic disparities and pre-existing medical conditions disproportionately increased the risk of SMM and mortality in patients with HDP. These findings highlight the need for targeted clinical interventions and policy efforts to reduce health inequities and improve maternal outcomes.