{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:13:55Z","timestamp":1792588435305,"version":"4.5.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"\n Background<\/jats:title>\n Hypertensive disorders of pregnancy (HDP) are major obstetric complications that seriously threaten maternal and neonatal health. Current research predominantly focuses on preeclampsia (PE). However, systematic comparisons across all four HDP subtypes\u2014gestational hypertension (GH), preeclampsia (PE), chronic hypertension (CH), and superimposed preeclampsia (SPE) remain limited, hindering a deeper understanding of their heterogeneous risks and precise management.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to systematically analyze the epidemiological trends, independent risk factors, and differential impacts on maternal and neonatal outcomes of HDP and its subtypes, based on large\u2013sample clinical data.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective cohort study was conducted at a single tertiary care center in southern China, including 20,081 pregnant women who delivered at Guangxi Zhuang Autonomous Region People's Hospital between January 2019 and December 2024. Participants were classified into an HDP group (\n n<\/jats:italic>\n \u2009=\u20091,334) and a non\u2013HDP group (\n n<\/jats:italic>\n \u2009=\u200918,747) based on discharge diagnoses. The HDP group was further subdivided into GH, PE, CH, and SPE. Baseline characteristics and pregnancy outcomes were collected. Multinomial logistic regression was used to identify factors associated with each HDP subtype vs. non-HDP. Multivariate logistic regression was used to assess associations between HDP subtypes and adverse outcomes, and adjusted models were constructed to assess independent risks. Given the small SPE sample (\n n<\/jats:italic>\n \u2009=\u200924), CH and SPE were combined (CH-SPE) for multivariable analyses to ensure model stability. Sensitivity analyses separating CH and SPE were also performed to assess the robustness of findings.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n From 2019 to 2024, the overall incidence of HDP was 6.6%, with CH incidence increased by 78.2% (from 0.6% to 1.0%), and SPE incidence increased from 0.1% in 2019 to 0.7% in 2024. Multinomial analysis identified advanced maternal age (\u226535 years), pre\u2013pregnancy overweight\/obesity, elevated fasting blood glucose (FBG), and gestational diabetes mellitus (GDM) as common risk factors for all HDP subtypes. Significant heterogeneity was observed among subtypes: PE demonstrated the strongest association with twin pregnancy (\n OR<\/jats:italic>\n =4.071, 95%\n CI<\/jats:italic>\n : 2.843\u2013\u20135.828), and elevated serum creatinine (Cr) was a specific risk factor for PE. CH\u2013SPE was significantly associated with assisted reproductive technology (ART) (\n OR<\/jats:italic>\n =2.032, 95%\n CI<\/jats:italic>\n : 2.278\u2013\u20133.230), while higher education level was a unique protective factor (Postgraduate vs. Junior high school or below:\n OR<\/jats:italic>\n =0.413, 95%\n CI<\/jats:italic>\n : 0.259\u2013\u20130.660). All HDP subtypes significantly increased the risks of cesarean delivery with CH\u2013SPE group (adjusted\n OR<\/jats:italic>\n =3.399, 95%\n CI<\/jats:italic>\n : 2.408\u2013\u20134.798) having the highest risk. Adverse neonatal outcomes (LBW and SGA) were predominantly concentrated in the PE and CH\u2013SPE subtypes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Significant heterogeneity exists in risk factors and maternal\u2013neonatal outcomes across different HDP subtypes. This study highlights the rapidly increasing incidence and unique risk profiles of chronic hypertension\u2013based subtypes, emphasizing the urgency for precise screening and management pre\u2013pregnancy and during early gestation. The findings provide important evidence for subtype\u2013stratified risk assessment and individualized clinical intervention in HDP.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1781870","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:30:08Z","timestamp":1785735008000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Hypertensive disorders of pregnancy: heterogeneity in risk factors and maternal and neonatal outcomes across subtypes\u2014a 6\u2013year retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Li","family":"Jing","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Dan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mo","family":"Jiacheng","sequence":"additional","affiliation":[{"name":"Department of Information, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhang","family":"Chun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhang","family":"Jihong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Yanqun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Xuxia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Guangxi Medical Academy & Guangxi Zhuang Autonomous Region People\u2019s Hospital","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"582","DOI":"10.5694\/mja2.52312","article-title":"A summary of the 2023 society of obstetric medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline","volume":"220","author":"Shanmugalingam","year":"2024","journal-title":"Med J Aust"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e88","DOI":"10.1161\/HYPERTENSIONAHA.124.23765","article-title":"Epidemiology of maternal hypertensive disorders","volume":"82","author":"Zhao","year":"2025","journal-title":"Hypertension"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3749","DOI":"10.1093\/eurheartj\/ehac308","article-title":"Hypertensive disorders of pregnant women with heart disease: the ESC EORP ROPAC registry","volume":"43","author":"Ramlakhan","year":"2022","journal-title":"Eur Heart J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e218401","DOI":"10.1001\/jamanetworkopen.2021.8401","article-title":"Preeclampsia prevalence, risk factors, and pregnancy outcomes in Sweden and China","volume":"4","author":"Yang","year":"2021","journal-title":"JAMA Netw Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1161\/HYPERTENSIONAHA.124.24394","article-title":"Vascular assessment stratifying preeclampsia risk in overweight\/obese women","volume":"82","author":"Chatzakis","year":"2025","journal-title":"Hypertension"},{"key":"B6","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.ajog.2024.04.037","article-title":"Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence","volume":"232","author":"Venkatesh","year":"2025","journal-title":"Am J Obstet Gynecol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"89","DOI":"10.3892\/ijmm.2023.5292","article-title":"Predictive value of the sFlt-1\/PlGF ratio in women with suspected preeclampsia: an update (review)","volume":"52","author":"Velegrakis","year":"2023","journal-title":"Int J Mol Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.preghy.2021.02.001","article-title":"Prevalence of hypertensive disorders in pregnancy in China: a systematic review and meta\u2013analysis","volume":"24","author":"Li","year":"2021","journal-title":"Preg Hyper"},{"key":"B9","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3760\/cma.j.cn112141-20200114-00039","article-title":"Guidelines for diagnosis and treatment of hypertensive disorders in pregnancy (2020)","volume":"55","year":"2020","journal-title":"Chinese J Obstet Gynecol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1161\/HYPERTENSIONAHA.117.10803","article-title":"International society for the study of hypertension in pregnancy (ISSHP). hypertensive disorders of pregnancy: iSSHP classification, diagnosis, and management recommendations for international practice","volume":"72","author":"Brown","year":"2018","journal-title":"Hypertension"},{"key":"B11","volume-title":"Physical status: The use of and Interpretation of Anthropometry, Report of a wHO Expert Committee. wHO Technical Report Series No. 854","year":"1995"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3760\/cma.j.cn112141-20220127-00052","article-title":"Guideline of diagnosis and treatment of hyperglycemia in pregnancy(2022)[part one]","volume":"57","year":"2022","journal-title":"Zhonghua Fuchanke Zazhi"},{"key":"B13","doi-asserted-by":"publisher","first-page":"858","DOI":"10.2337\/dc20-2941","article-title":"Resolving the gestational diabetes diagnosis conundrum: the need for a randomized controlled trial of treatment","volume":"44","author":"Bilous","year":"2021","journal-title":"Diabetes Care"},{"key":"B14","doi-asserted-by":"publisher","first-page":"738","DOI":"10.3760\/cma.j.cn112140-20200316-00242","volume":"58","year":"2020","journal-title":"Zhonghua Erke Zazhi"},{"key":"B15","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.fertnstert.2024.05.140","article-title":"Addressing weight bias in reproductive medicine: a call to revisit body mass index restrictions for in vitro fertilization treatment","volume":"122","author":"Boots","year":"2024","journal-title":"Fertil Steril"},{"key":"B16","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/bs.acc.2025.06.003","article-title":"MicroRNAs in metabolic syndrome: mechanisms, diagnosis, and therapy","volume":"128","author":"Rahman","year":"2025","journal-title":"Adv Clin Chem"},{"key":"B17","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/j.ajog.2024.08.045","article-title":"Maternal vascular\u2013placental axis in the third trimester in women with gestational diabetes mellitus, hypertensive disorders, and unaffected pregnancies","volume":"232","author":"Chatzakis","year":"2025","journal-title":"Am J Obstet Gynecol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2967","DOI":"10.3390\/ijms26072967","article-title":"Increased preeclampsia risk in GDM pregnancies: the role of SIRT1 rs12778366 polymorphism and telomere length","volume":"26","author":"Dmitrenko","year":"2025","journal-title":"Int J Mol Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"730.e1","DOI":"10.1016\/j.ajog.2022.11.1290","article-title":"Intertwin growth discordance throughout gestation and hypertensive disorders of pregnancy","volume":"228","author":"Zhu","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"S895","DOI":"10.1016\/j.ajog.2020.09.026","article-title":"Failure of physiological transformation and spiral artery atherosis: their roles in preeclampsia","volume":"226","author":"Staff","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"4231","DOI":"10.1002\/cphy.210051","article-title":"Preeclampsia and the kidney: pathophysiology and clinical implications","volume":"13","author":"Dines","year":"2023","journal-title":"Compr Physiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e022658","DOI":"10.1161\/JAHA.121.022658","article-title":"In\u2013hospital complications in pregnancies conceived by assisted reproductive technology","volume":"11","author":"Wu","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"B23","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1097\/AOG.0000000000005342","article-title":"Chronic hypertension in pregnancy and racial\u2013ethnic disparities in complications","volume":"142","author":"Leonard","year":"2023","journal-title":"Obstet Gynecol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1093\/nutrit\/nuad066","article-title":"The dilemma of sodium intake in preeclampsia: beneficial or detrimental?","volume":"82","author":"Afsar","year":"2024","journal-title":"Nutr Rev"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2307","DOI":"10.1042\/CS20190070","article-title":"Epigenetic processes during preeclampsia and effects on fetal development and chronic health","volume":"135","author":"Ashraf","year":"2021","journal-title":"Clin Sci (Lond)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"39602","DOI":"10.31083\/CEOG39602","article-title":"Research progress on placenta-targeted drug delivery in the treatment of preeclampsia","volume":"52","author":"Chen","year":"2025","journal-title":"Clin Exp Obstet Gynecol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1038\/s41572-023-00417-6","article-title":"Pre\u2013eclampsia","volume":"9","author":"Dimitriadis","year":"2023","journal-title":"Nat Rev Dis Primers"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1781870\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:30:11Z","timestamp":1785735011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1781870\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":27,"alternative-id":["10.3389\/fcvm.2026.1781870"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1781870","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1781870"}}