• Susie Dzakpasu, Chantal Nelson, Elizabeth K Darling, Wesley Edwards, Phil A Murphy, Heather Scott, Michiel Van den Hof, Joel G Ray, and Canadian Perinatal Surveillance System.
• Maternal and Infant Health Section (Dzakpasu, Nelson), Public Health Agency of Canada, Ottawa, Ont.; McMaster Midwifery Research Centre, and Department of Obstetrics and Gynecology (Darling), McMaster University, Hamilton, Ont.; Department of Anesthesia and Pain Medicine, and Faculty of Medicine (Edwards), University of Ottawa, Ottawa, Ont.; Newfoundland and Labrador Health Services (Murphy), St. John's, NL; Department of Obstetrics and Gynaecology (Scott, Van den Hof), IWK Health Centre; Dalhousie University (Scott, Van den Hof), Halifax, NS; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital; Departments of Medicine, Health Policy Management and Evaluation (Ray), University of Toronto, Ont. susie.dzakpasu@phac-aspc.gc.ca.
• CMAJ. 2024 Jul 28; 196 (26): E897E904E897-E904.

BackgroundHypertensive disorders of pregnancy (HDP) are a leading cause of severe maternal morbidity (SMM). We sought to explore trends in HDP and related morbidity outcomes in Canada.MethodsIn this retrospective population-based study, we used hospital discharge data from Canada, excluding Quebec, to identify females who had an HDP diagnosis during a birth admission between 2012 and 2021. We analyzed temporal and geographical trends in HDP, as well as temporal trends in adverse outcomes associated with HDP.ResultsAmong 2 804 473 hospital admissions for birth between 2012 and 2021, the rate of any HDP increased from 6.1% to 8.5%, including pre-existing hypertension (0.6% to 0.9%), gestational hypertension (3.9% to 5.1%), and preeclampsia (1.6% to 2.6%). For 2017-2021 combined, relative to Ontario (6.9%), HDP were significantly more prevalent in nearly all other Canadian regions. For example, in Newfoundland and Labrador, the rate was 10.7% (unadjusted rate ratio 1.56, 95% confidence interval 1.49-1.63). Among females with any HDP, rates of cesarean delivery rose from 42.0% in 2012 to 44.3% in 2021, as did acute renal failure (0.4% to 0.6%), while rates of early preterm delivery, intrauterine fetal death, maternal hospital length of stay (≥ 7 d), admission to the maternal intensive care unit, severe hemorrhage, and SMM trended downward.InterpretationThe rate of HDP has risen across Canada, with a concomitant decline in some HDP-associated morbidities. Ongoing surveillance of HDP is needed to assess the factors associated with temporal trends, including the effectiveness of evolving HDP prevention and management efforts.© 2024 CMA Impact Inc. or its licensors.

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