(1189) Increased Prevalence of Hypertensive Morbidity in Pregnancy During the Coronavirus Pandemic Demonstrates Geospatial Socioeconomic Associations

To characterize psychosocial community associations during the COVID-19 pandemic with the prevalence of hypertensive morbidity during pregnancy.

Study Design:

Retrospective cohort study of a 10-county birth certificate database merged with publicly available community resource data delineating a pre-pandemic cohort from April 2018 to February 2019 and a pandemic cohort from April 2020 to February 2021, with transitional deliveries during the emerging pandemic excluded. Cohorts were analyzed for the primary outcome of diagnosed hypertensive (HTN) morbidity in pregnancy (including pregnancy-related HTN and chronic HTN). Patient-level outcome data were geospatially associated with poverty, health insurance status and crime data from the US census Bureau with analysis performed via ANOVA, multi-variable regression, and GIS mapping.

Results:

19108 deliveries from 63 zip codes in 10 counties were included, 9753 in the pre-pandemic group and 9354 in the pandemic group. Prevalence of HTN morbidity during the COVID pandemic increased (18.8% from 14.7%, OR 1.42, CI 1.31-1.52, p< 0.01), persisting on multivariable regression addressing potential confounders (aOR 1.40, CI 1.30,1.51, p< 0.01), and demonstrating heterogenous geographic distribution (Figure 1). Increased prevalence of HTN morbidity during the pandemic was persistent when regions with similar socioeconomic metrics were combined for poverty rates, insurance access, and crime rates (p < 0.01 respectively). While there was no observed difference associated with the varying levels of insurance access on HTN morbidity (p=0.27, F=1.33), higher crime rates were associated with greater HTN morbidity (p < 0.01, F=6.14) and extremes of poverty both high and low were also associated with greater HTN morbidity (p=0.03, F=3.20) (Figure 2).

Conclusion:

These data demonstrate an increased prevalence of hypertensive morbidity in pregnancy during the COVID-19 pandemic with accentuated variation across communities with concentrations of crime and poverty. Community investment strategies may represent an avenue to positively impact hypertensive morbidity in pregnancy.