{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:59:39Z","timestamp":1780898379617,"version":"3.54.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004735","name":"Hunan Provincial Natural Science Foundation of China","doi-asserted-by":"crossref","award":["2026JJ60553"],"award-info":[{"award-number":["2026JJ60553"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Key Clinical Specialty Scientific Research Project","award":["Z2023106"],"award-info":[{"award-number":["Z2023106"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare adverse pregnancy outcomes (APOs) between subtypes of hypertensive disorders of pregnancy (HDP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012\u20132022. HDP was classified into four subtypes: preeclampsia-eclampsia (PE), chronic hypertension (CH), chronic hypertension with superimposed preeclampsia (CHSP), and gestational hypertension (GH). Pearson\u2019s chi-square tests were used to determine if there were significant differences in the prevalence of APOs between HDP subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 780,359 pregnant women were included, and 38,397 HDPs were identified, including 17,782 PEs (46.31%), 15,889 GHs (41.38%), 3,340 CHs (8.70%), and 1,386 CHSPs (3.61%). The overall prevalence of APOs among pregnant women with HDP was as follows: anemia (30.78%), diabetes mellitus (20.33%), preterm birth (19.53%), low birthweight (18.74%), hemorrhage disorder (9.07%), infection (4.71%), liver disease (2.55%), stillbirth and neonatal death (2.38%), maternal near-miss (1.57%), kidney disease (0.98%), heart disease (0.65%), pulmonary disease (0.11%), embolism (0.03%), and maternal death (0.02%). There were significant differences in the prevalence of all APOs between HDP subtypes, except for pulmonary disease, embolism, and maternal death (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Compared with other subtypes, anemia was more common in PE (32.97%), diabetes mellitus was more common in CH (25.27%) and CHSP (25.11%), preterm birth was more common in CHSP (37.01%) and PE (27.76%), low birthweight was more common in CHSP (31.39%) and PE (27.72%), hemorrhage disorder was more common in PE (9.86%), infection was more common in PE (5.20%) and CHSP (5.05%) than other subtypes; liver disease was more common in CHSP (4.11%), stillbirth and neonatal death were more common in CHSP (6.64%) and PE (3.18%), maternal near-miss was more common in PE (2.47%) and CHSP (2.31%), kidney disease was more common in CHSP (3.97%) and CH (1.44%), heart disease was more common in CHSP (1.15%) and CH (0.96%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most APOs were more common in both CHSP and PE than other subtypes, including preterm birth, low birthweight, infection, stillbirth and neonatal death, and maternal near-miss; diabetes mellitus, liver disease, kidney disease, and heart disease were common in CHSP but not PE; anemia and hemorrhage disorder were common in PE but not CHSP; diabetes mellitus, kidney disease and heart disease were common in CH. Our finding is useful for clinical counseling and future in-depth studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1817901","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:33:04Z","timestamp":1780896784000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adverse pregnancy outcomes in hypertensive disorders of pregnancy: an in-depth comparison between subtypes"],"prefix":"10.3389","volume":"13","author":[{"given":"Xu","family":"Zhou","sequence":"first","affiliation":[{"name":"NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinglan","family":"Wu","sequence":"additional","affiliation":[{"name":"NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Han","sequence":"additional","affiliation":[{"name":"NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Chen","sequence":"additional","affiliation":[{"name":"NHC Key Laboratory of Birth Defect for Research and Prevention (Hunan Provincial Maternal and Child Health Care Hospital)","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.preghy.2021.09.008","article-title":"The 2021 International Society for the Study of hypertension in pregnancy classification, diagnosis & management recommendations for international practice","volume":"27","author":"Magee","year":"2022","journal-title":"Pregnancy Hypertens"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1038\/hr.2016.126","article-title":"Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis","volume":"40","author":"Umesawa","year":"2017","journal-title":"Hypertens Res"},{"key":"ref3","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-analysis","volume":"24","author":"Li","year":"2021","journal-title":"Pregnancy Hypertens"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1415696","DOI":"10.3389\/fmed.2024.1415696","article-title":"Hypertensive disorders of pregnancy in Hunan Province, China, 2012-2022","volume":"11","author":"Zhou","year":"2024","journal-title":"Front Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1097\/01.Aog.0000437382.03963.88","article-title":"Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists\u2019 task force on hypertension during pregnancy","volume":"122","author":"Roberts","year":"2013","journal-title":"Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e323","DOI":"10.1016\/s2214-109x(14)70227-x","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"Say","year":"2014","journal-title":"Lancet Glob Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1161\/01.Hyp.0000054981.03589.E9","article-title":"Summary of the NHLBI working group on research on hypertension during pregnancy","volume":"41","author":"Roberts","year":"2003","journal-title":"Hypertension"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1161\/hyp.0000000000000208","article-title":"Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: a scientific statement from the American Heart 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