{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T12:45:39Z","timestamp":1765111539767,"version":"3.46.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD084819","R01HD099197","K23HD109426"],"award-info":[{"award-number":["R01HD084819","R01HD099197","K23HD109426"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Chronic hypertension in pregnancy has doubled in prevalence over the past 15 years, but little is known about pregnancy outcomes at hospitals with different characteristics. We evaluated the association between hospital birth volume and rurality with risk of adverse pregnancy outcomes among individuals with chronic hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based study using linked vital statistics and birth hospitalization discharge data from Michigan, Oregon, South Carolina (2008\u20132020), and Pennsylvania (2008\u20132018). We classified hospitals based on federal rural\u2013urban county classifications and annual birth volume. The primary outcome was a composite measure of adverse pregnancy outcomes, including superimposed preeclampsia or eclampsia, severe obstetric morbidities, and fetal\/neonatal morbidities. We used multivariable modified Poisson regression models with hospital fixed effects and robust standard errors to estimate the risk ratios (RRs) with 95% confidence intervals (CIs) for the primary outcome and the component outcomes for each hospital group compared with high\u2010volume urban hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 106,991 births to individuals with chronic hypertension, the crude incidence of the primary adverse pregnancy outcome was highest in high\u2010volume urban hospitals (49.5%) and lowest in low\u2010volume rural hospitals (34.4%). Additionally, a higher proportion of individuals giving birth at high\u2010volume urban hospitals had a high (\u226510) obstetric comorbidity score (45%\u00a0vs. 24\u201327% at rural and low\u2010volume urban hospitals). After robust adjustment for clinical characteristics in regression models, however, no differences between hospital groups were evident. Among primary outcome components, only the risk of superimposed preeclampsia or eclampsia was higher in low\u2010volume urban hospitals (adjusted RR: 1.21; 95% CI: 1.09\u20131.34) and medium\u2010volume rural hospitals (adjusted RR: 1.26; 95% CI: 1.05\u20131.50).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adverse pregnancy outcomes among individuals with chronic hypertension were largely similar across hospital volume and rurality groups, after accounting for differences in case mix. However, superimposed preeclampsia or eclampsia was highest at medium\u2010volume rural and low\u2010volume urban hospitals, suggesting potential opportunities for improved prenatal clinical management of chronic hypertension.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70115","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T10:27:05Z","timestamp":1758623225000},"source":"Crossref","is-referenced-by-count":0,"title":["Hospital birth volume and rurality: Associations with pregnancy outcomes among individuals with chronic hypertension"],"prefix":"10.1002","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8213-1319","authenticated-orcid":false,"given":"Stephanie A.","family":"Leonard","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Stanford University  Stanford California USA"},{"name":"Department of Anesthesiology Perioperative and Pain Medicine Stanford University  Stanford 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USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciaran S.","family":"Phibb","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Stanford University  Stanford California USA"},{"name":"Health Economics Resource Center Veterans Affairs Palo Alto Healthcare System  Menlo Park California USA"},{"name":"Department of Health Policy Stanford University  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8436-4351","authenticated-orcid":false,"given":"Sara C.","family":"Handley","sequence":"additional","affiliation":[{"name":"Division of Neonatology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics The University of Pennsylvania  Philadelphia Pennsylvania 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