- Design
- Cross-sectional study of national vital statistics
- Population
- 33,363,927 US live births, 2016–2024
- Primary outcome
- Age-standardised rate of hypertensive disorders of pregnancy
- Effect
- 62.7 to 109.1 per 1,000 live births (+74%; average annual change 7.2%)
A cross-sectional study used US national birth certificate data on 33,363,927 live births from 2016 to 2024. Age-standardised rates of hypertensive disorders of pregnancy rose from 62.7 to 109.1 per 1,000 live births, an average annual rise of 7.2%, with the trend steepening from 2021.
The increase was seen in every racial and ethnic group. Relative growth was fastest among non-Hispanic Asian (9.7% a year) and Multiracial women (7.9% a year), while absolute rates in 2024 were highest among American Indian or Alaska Native (143.7 per 1,000) and Black women (132.7 per 1,000).
Birth certificate data cannot separate a true rise in disease from changes in recording, diagnostic thresholds or maternal age and weight. Even so, about one birth in nine now carries this diagnosis in US data, which makes postpartum blood pressure follow-up and long-term cardiovascular risk counselling a high-volume task rather than a niche one.
- Assume hypertensive disorders of pregnancy are common enough to plan services around, not handle case by case
- Book a postpartum blood pressure check before discharge for every woman with the diagnosis
- Record the diagnosis in the long-term problem list so primary care sees the cardiovascular risk
- Check aspirin eligibility early in pregnancy for women with risk factors for pre-eclampsia
Why it matters
A diagnosis that touches one birth in nine is a workload and follow-up problem, not only an obstetric one.
Don't overread it
Birth certificate coding can change over time — part of the rise may reflect better recording rather than more disease.
The statistics, in plain English
The rate went from about 6 in 100 births to about 11 in 100. 'Age-standardised' means the authors adjusted for mothers getting older over time, so ageing alone does not explain the rise. The annual percentage change describes the average yearly growth across the whole period.
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