Maternal chronic hypertension in women veterans.



To describe the prevalence of maternal chronic hypertension (MCH), assess how frequently blood pressure is controlled before pregnancy among those with MCH, and explore management practices for antihypertensive medications (AHM) during the pre-pregnancy and pregnancy periods.

Data sources, study setting, and study design

We conducted a descriptive observational study using data abstracted from the Veterans Health Administration (VA) inclusive of approximately 11 million Veterans utilizing the VA in fiscal years 2010-2019.

Data collection/extraction methods

Veterans aged 18-50 were included if they had a diagnosis of chronic hypertension before a documented pregnancy in the VA EMR. We identified chronic hypertension and pregnancy with diagnosis codes and defined uncontrolled blood pressure as ≥140/90 mm Hg on at least one measurement in the year before pregnancy. Sensitivity models were conducted for individuals with at least two blood pressure measurements in the year prior to pregnancy. Multivariable logistic regression explored the association of covariates with recommended and non-recommended AHMs received 0-6 months before pregnancy and during pregnancy.

Principal findings

In total, 8% (3767/46,178) of Veterans with a documented pregnancy in VA data had MCH. Among 2750 with MCH meeting inclusion criteria, 60% (n = 1626) had uncontrolled blood pressure on at least one BP reading and 31% (n = 846) had uncontrolled blood pressure on at least two BP readings in the year before pregnancy. For medications, 16% (n = 437) received a non-recommended AHM during pregnancy. Chronic kidney disease (OR = 3.2; 1.6-6.4) and diabetes (OR = 2.3; 1.7-3.0) were most strongly associated with use of a non-recommended AHM during pregnancy.


Interventions are needed to decrease the prevalence of MCH, improve preconception blood pressure control, and ensure optimal pharmacologic antihypertensive management among Veterans of childbearing potential.





Published Version (Please cite this version)


Publication Info

Harding, Ceshae C, Karen M Goldstein, Sarah A Goldstein, Sarahn M Wheeler, Nia S Mitchell and Laurel A Copeland (2024). Maternal chronic hypertension in women veterans. Health services research, 59(2). p. e14277. 10.1111/1475-6773.14277 Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Ceshae Harding

Medical Instructor in the Department of Medicine

Karen M. Goldstein

Associate Professor of Medicine

Dr. Goldstein's research interests include women's health, cardiovascular risk reduction, evidence synthesis methodology and peer support.


Sarahn M Wheeler

Associate Professor of Obstetrics and Gynecology

Dr. Sarahn M. Wheeler is a practicing maternal-fetal medicine specialist at Duke University Medical Center. Dr. Wheeler was born and raised in Mt. Laurel, NJ. She graduated magna cum laude from Harvard University. She completed medical school at the University of Chicago’s Pritzker School of Medicine. Dr. Wheeler went on to residency training in Obstetrics and Gynecology at the Johns Hopkins Hospital. Dr. Wheeler completed her maternal-fetal medicine sup-specialty training at Duke University in June of 2016.

Dr. Wheeler currently serves as Assistant Professor in the Duke University School of Medicine. In this role, Dr. Wheeler is both a practicing clinician and research faculty. in her clinical role, Dr. Wheeler is the director of Duke's Prematurity Prevention Program, a specialty clinic that is geared for women with risk factors for preterm birth.  In her research role, Dr. Wheeler has published several peer-reviewed articles on topics ranging from fetal brain injury to vaccination during pregnancy. Dr. Wheeler’s current research focus is on race disparities in preterm birth. She is actively involved in research to develop interventions to improve utilization of preterm birth prevention therapies.

Dr. Wheeler also serves as the Director of Diversity, Equity and Inclusion for the OB/GYN department.  In this role she leads efforts to ensure an inclusive environment for the diverse patients, faculty, staff and trainees within Duke OB/GYN.


Nia Schwann Mitchell

Associate Professor of Medicine

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