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Association between hypertensive disorders of pregnancy and neuraxial labor analgesia: a population-based study.
Abstract Number: S2A-3
Abstract Type: Original Research
Introduction: Neuraxial labor analgesia (NA) is recommended for women with preeclampsia (without severe thrombocytopenia).(1) However, it is unclear whether rates of NA differ between normotensive women vs. women with hypertensive disorders of pregnancy (HTN).
Methods: Using United States natality data, we performed a population-based study of 18,086,027 women of 24-42 weeks’ gestation who underwent a trial of labor between 2009-2015. Patients with gestational hypertension, preeclampsia or eclampsia were classified as HTN. The overall and annual prevalence estimates of NA according to blood pressure class were calculated. We performed multivariable Poisson regression to calculate the crude and adjusted relative risk (RR) of NA for women with HTN compared to normotensive women. We adjusted for the following covariates in our multivariable model: age, body mass index, race/ethnicity, insurance, education, marital status, multiple gestation, fetal presentation at delivery, trimester prenatal care began, prenatal diabetes, prenatal hypertension, previous cesarean delivery, previous live birth, gestational diabetes, gestational age at delivery, attendant at birth, year of delivery, and state of delivery.
Results: Our study population comprised 804,984 (4.5%) women with HTN and 17,231,376 (95.3%) normotensive women; 49,667 (0.3%) women had missing data for HTN status. The overall prevalence of NA was higher among women with HTN compared to normotensive women (81.4% vs. 70.4%, respectively; P<0.001). The prevalence of NA among HTN and normotensive women by year are presented in the Figure. We did not detect a significant between-group difference for the percent change in NA prevalence from 2009 to 2015 (3.7% [HTN women] vs. 5.1% [normotensive women]; P=0.3). In our unadjusted analysis, the risk of receiving NA was higher among women with HTN (RR=1.16; 95% confidence intervals (CI)=1.15-1.16) compared with normotensive women. After adjusting for potential confounders, women with HTN had a modestly increased risk of NA vs normotensive women (adjusted RR=1.07; 95% CI=1.07-1.08).
Conclusion: Our findings suggest that the prevalence and likelihood of receiving NA is higher among women with HTN compared to normotensive women. Population-wide studies are needed to assess whether NA use improves maternal and perinatal outcomes among women with HTN, and whether NA use should be further encouraged in this patient group.
References: (1) Anesthesiology 2016; 124: 270-300