Title

Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018

UMMS Affiliation

Division of Cardiovascular Medicine, Department of Medicine; Department of Obstetrics and Gynecology; Department of Population and Quantitative Health Sciences; School of Medicine

Publication Date

2022-04-01

Document Type

Article

Disciplines

Cardiovascular Diseases | Epidemiology | Health Services Research | Women's Health

Abstract

BACKGROUND: Hypertension (HTN) in pregnancy is a leading cause of maternal mortality in the United States. Contraception is widely used, and estrogen-based combined hormonal forms are known to increase blood pressure (BP). With nearly half of pregnancies unplanned and many antihypertensive medications teratogenic, appropriate contraception is critical in child-bearing age women with HTN.

METHODS: Using the National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2018, we evaluated contraception and antihypertensive medication use in women of child-bearing age (20-50 years). Women who had undergone sterilization or menopause were excluded. HTN was defined based on a self-reported provider diagnosis and BP > /=130/80 mm Hg or antihypertensive medication use. Contraception included non-barrier methods (pills/patch/ring, injections, long-acting reversible contraceptives) or consistent condom use. Multivariable logistic regression was used to model the odds of contraception use. Temporal trends in contraception use were reported.

RESULTS: Of the 8726 women, 12.4% had HTN with mean age (standard error) 36.0 (0.3) years. In women with HTN, 9.2% used non-barrier contraception and 10.4% used condoms only. Over half (52.7%) of women with HTN on antihypertensive medications were taking medications contraindicated in pregnancy, with no difference seen by contraceptive status. In logistic regression models, contraceptive use was lower in the older-aged women. In women with HTN on non-barrier contraception, combined hormonal contraceptive use declined, from 100% (2001-2006) to 81.4% (2013-2018, P < 0.001).

CONCLUSIONS: Many women with self-reported HTN are not using adequate contraception. Of the small proportion on non-barrier contraceptives, the majority are using estrogen-based, BP-raising methods.

Keywords

antihypertensive agents, contraception, hypertension, National Health and Nutrition Examination Surveys, pregnancy

DOI of Published Version

10.1097/HJH.0000000000003077

Source

Kovell LC, Meyerovitz CV, Skaritanov E, Ayturk D, Person SD, Kumaraswami T, Juraschek SP, Moore Simas TA. Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018. J Hypertens. 2022 Apr 1;40(4):776-784. doi: 10.1097/HJH.0000000000003077. PMID: 35081582. Link to article on publisher's site

Journal/Book/Conference Title

Journal of hypertension

PubMed ID

35081582

Related Resources

Link to Article in PubMed

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