Maternal chronic hypertension in women veterans.

dc.contributor.author

Harding, Ceshae C

dc.contributor.author

Goldstein, Karen M

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Goldstein, Sarah A

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Wheeler, Sarahn M

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Mitchell, Nia S

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Copeland, Laurel A

dc.date.accessioned

2024-05-22T22:17:34Z

dc.date.available

2024-05-22T22:17:34Z

dc.date.issued

2024-04

dc.description.abstract

Objective

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.

Conclusions

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.
dc.identifier.issn

0017-9124

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1475-6773

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https://hdl.handle.net/10161/30729

dc.language

eng

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Wiley

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Health services research

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10.1111/1475-6773.14277

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Humans

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Hypertension

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Diabetes Mellitus

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Antihypertensive Agents

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Pregnancy

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Blood Pressure

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Veterans

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Female

dc.title

Maternal chronic hypertension in women veterans.

dc.type

Journal article

duke.contributor.orcid

Harding, Ceshae C|0000-0001-9930-0852

duke.contributor.orcid

Goldstein, Karen M|0000-0003-4419-5869

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Wheeler, Sarahn M|0000-0001-8384-3721

pubs.begin-page

e14277

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2

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Duke

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School of Medicine

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Clinical Science Departments

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Institutes and Centers

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Medicine

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Obstetrics and Gynecology

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Medicine, General Internal Medicine

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Obstetrics and Gynecology, Maternal Fetal Medicine

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Duke Cancer Institute

pubs.publication-status

Published

pubs.volume

59

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