Contemporary patterns of diuretic utilization among pregnant women with cardiovascular conditions in the U.S.: A population-based study

Author(s)

• Rupal Aroza, University of Kentucky
• Daniela Moga, University of Kentucky
• Christopher McLouth, University of Kentucky
• Patricia Freeman, University of Kentucky
• Olufunmilola Abraham, University of Kentucky
• Hend Mansoor, University of Kentucky

Description

Background: Diuretics are used to manage hypertension and heart failure; however, the data on their safety during pregnancy are limited. Objective: To examine contemporary trends in diuretic use among pregnant women with cardiovascular conditions in the United States from 2010 to 2023. Methods: We conducted a population-based study using two large U.S. administrative claims databases; Merative MarketScan (commercial) and Medicaid Analytic eXtract (public) from 2010 to 2023. Pregnant women aged 12‚Äì55 were identified using a previously validated pregnancy identification algorithm. We included only women with continuous enrollment from one year before last menstrual period (LMP) date through pregnancy end. Diuretic exposure was assessed from 90 days before LMP through pregnancy end. We evaluated temporal trends in diuretic use overall, across perinatal periods, and among pregnancies complicated by hypertensive disorders of pregnancy and heart failure. Patterns of diuretic class use, as monotherapy or combination therapy, were examined overall and across each perinatal period among pregnancies with cardiovascular conditions.   Results: Among 2,527,591 pregnancies who met continuous eligibility, 1.4% had diuretic exposure. Diuretics use in U.S. pregnancies was low, rising from 0.97% in 2010 to 1.79% in 2023. Use from 2010 to 2023 was highest in the first trimester (0.53% to 1.21%), but declined across second (0.20% to 0.19%) and third trimesters (0.55% to 0.07%) respectively. Trends varied by cardiovascular condition, with moderately higher use in hypertensive disorders of pregnancy (0.68% in 2010 to 0.82% in 2023) than in heart failure (0.02% in 2010 to 0.03% in 2023). Thiazide monotherapy was the most commonly utilized diuretic class overall and in hypertensive pregnancies, with higher use during pre-pregnancy and first trimester periods. Conclusion: In this contemporary study, diuretic use was low overall and was mainly used during the first trimester. Future studies should evaluate safety of diuretics use on maternal and neonatal outcomes.

Publication Info

2026.