Risk factors for severe maternal morbidity in patients with hypertensive disorder of pregnancy: A retrospective study

To identify significant risk factors associated with severe maternal morbidity(SMM) in patients with hypertensive disorder of pregnancy (HDP).

This retrospective study analyzed clinical data from patients with HDP who delivered at Fujian Maternity and Children Health Hospital between January 2013 and March 2022. Univariate logistic regression analysis was performed to identify risk factors for developing SMM. Significant risk factors (P < 0.05) were considered for inclusion in multivariate logistic regression using stepwise regression with forward and backward selection.

Of 3133 HDP patients included in the study, 365 met the diagnostic criteria of SMM and were included in the SMM group, while 2768 patients comprised the control group. The SMM group had a significantly higher incidence of gestational hypertension diagnosed at ≤ 34 weeks of gestation compared to the control group (30.14% vs. 12.64%, p<0.0001). Patients in the SMM group had a higher incidence of previous history of preeclampsia compared to the control group (1.64% vs. 0.25%, p=0.0001). Logistic regression analysis identified parity (OR, 1.37; CI, 1.05-1.78; p=0.0205), gestational age of diagnosis (OR, 2.22; CI, 1.68-2.92; p<0.0001), iron supplementation (OR, 2.31; CI, 1.83-2.93; p<0.0001), and preeclampsia (OR, 3.10; CI, 2.42-3.98; p<0.0001) as significant risk factors for SMM. Stepwise regression analysis confirmed that parity (OR, 1.43; CI, 1.17-1.73; p=0.0004), gestational age of diagnosis (OR, 2.32; CI, 1.77-3.05; p<0.0001), iron supplementation (OR, 2.30; CI, 1.82-2.90; p<0.0001), and preeclampsia (OR, 3.34; CI, 2.63-4.24; p<0.0001) remained significantly associated with SMM.

Gestational age of diagnosis, iron supplementation, and history of preeclampsia were identified as risk factors of SMM in patients with HDP. Our results can help identify high-risk patients for early recognition and management of SMM.