Abstract Body (Do not enter title and authors here): Background: Hypertensive disorders of pregnancy (HDP) are characterized by dysregulated inflammatory responses at the cellular level and increased expression of pro-inflammatory cytokines. Patients with HDP have higher odds of autoimmune disorder diagnoses later in life. Patients with preexisting autoimmune diseases have greater risk of several adverse outcomes in pregnancy, including HDP, but the degree of increased risk is not well-understood.
Research Question: Is a preexisting inflammatory disorder associated with higher odds of HDP?
Methods: We identified patients within Penn Medicine with a delivery from 2012-2020 in a large urban academic center, excluding those with prior serious medical conditions. Covariates were obtained from the electronic medical record. Inflammatory disorders, including systemic lupus erythematosus (SLE), rheumatoid arthritis, Sjogren syndrome, poly- and dermatomyositis, inflammatory bowel disease, mixed connective tissue disease, multiple sclerosis, Addison disease, antiphospholipid syndrome, and type 1 diabetes, and the primary outcome of HDP diagnosis, including preeclampsia and gestational hypertension, were identified using ICD codes. Multivariable logistic regression was used to model the relationship between patient factors and HDP diagnosis. Sensitivity analyses were conducted excluding patients with SLE, as these patients are recommended to take low-dose aspirin for preeclampsia prevention.
Results: Among 37,733 patients, 804 (2.1%) had a pre-existing inflammatory disorder. The mean age for all patients was 30.3 years, 40% were Black, 34% had Medicaid insurance, and 63% were nulliparous. Overall, 25% of patients developed HDP, including 34% of those with an inflammatory disorder and 25% of those without. After adjusting for age, race/ethnicity, parity, and BMI, preexisting inflammatory disorders were associated with increased odds of HDP diagnosis (aOR 1.5, 95% CI 1.3 – 1.8). This relationship was similar after excluding patients with SLE.
Conclusions: Patients with inflammatory disorders have higher likelihood of HDP diagnosis during pregnancy. More intensive blood pressure monitoring, including at-home surveillance, should be part of care for patients with inflammatory disorders. Future work will study blood pressure patterns among these patients during pregnancy to identify if there are differences between those with and without inflammatory disorders.