Abstract 16425: Incidence of New-Onset Hypertensive Disorders of Pregnancy Before and During the Early COVID-19 Pandemic in the United States, 2018-2021

Introduction: The incidence of new-onset hypertensive disorders of pregnancy (HDP) has increased in recent years. During the COVID-19 pandemic, blood pressure control worsened in non-pregnant populations. Therefore, we sought to examine whether the incidence of HDP changed with the onset of the COVID-19 pandemic.

Methods: A serial cross-sectional study of nulliparous individuals aged 15-44 years with singleton live births was conducted using the National Center for Health Statistics Natality Data Files from 2018-2021. HDP was determined by the professional attendant at birth. Maternal social determinants of health (SDoH), including education level, Medicaid insurance, and rurality of residence, were self-reported. Interrupted time series analyses compared the monthly national incidence of HDP before (1/2018-2/2020) and during (5/2020-12/2021) the COVID-19 pandemic, overall and stratified by maternal SDoH, adjusting for seasonal autocorrelation.

Results: The sample included 5,246,061 pregnant individuals (22.2% Hispanic, 7.4% non-Hispanic Asian, 13.3% non-Hispanic Black, 53.8% non-Hispanic White). The incidence of HDP was 9.22% in 1/2018 and 12.15% in 12/2021. The incidence of HDP increased before (0.07±0.01%/month) and during the pandemic (0.06±0.01%/month), with no acceleration after pandemic onset (p=0.66, Figure ). There was no significant difference in monthly trends when stratified by maternal SDoH groups.

Conclusions: Nearly 1 in 8 individuals in 2021 had a pregnancy complicated by new-onset HDP in the US. While the early COVID-19 pandemic was not associated with a significant acceleration, the incidence of HDP continues to steadily increase.