Population-level trends, risk factors and predictors of hypertensive disorders of pregnancy in the U.S, 2014–2023

Abstract

Hypertensive disorders of pregnancy (HDP) remain a leading cause of maternal and perinatal morbidity in the United States. Despite advances in care, recent data suggest a rising prevalence. Using National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) natality data from 2014–2023 ( n = 37.7 million births), we examined temporal trends, risk factors, and outcomes associated with chronic hypertension (CH), gestational hypertension (GH), and eclampsia. HDP affected 9.9% of all pregnancies, increasing substantially across all racial/ethnic groups. Maternal obesity was the strongest modifiable predictor, with extreme obesity conferring > 6-fold higher odds of HDP. Non-Hispanic (NH) Black mothers had consistently higher prevalence of every subtype. HDP was strongly associated with preterm birth and low birth weight. Findings suggest that rising HDP burden reflects both true epidemiologic shifts and improved diagnostic awareness, with implications for prenatal care, equity-focused interventions, and intergenerational cardiometabolic health.