Rural–Urban Differences in Hypertensive Disorders of Pregnancy Within a Tertiary Care Referral Center: a Retrospective Cohort Study

Background Hypertensive disorders of pregnancy (HDP) are major contributors to maternal morbidity and mortality in the United States. Rural residence has been associated with worse maternal outcomes at the population level, but few studies have examined rural–urban differences within a single health system. Methods This retrospective cohort study included patients diagnosed with HDP who delivered at Aspirus St. Luke’s Hospital, a tertiary referral center serving rural and urban communities in northeastern Minnesota, from May 2019 through May 2024. Patients were classified as rural or urban using the 2023 Federal Office of Rural Health Policy ZIP code designations. Maternal characteristics, disease severity, management practices, and short-term maternal and neonatal outcomes were compared using bivariate and multivariable regression analyses. Results Among 782 patients, 281 resided in rural areas and 501 in urban areas. Baseline blood pressure and inpatient management, including magnesium sulfate use and discharge antihypertensive prescribing, were similar between groups. Rates of gestational hypertension, preeclampsia, and adverse maternal outcomes did not differ significantly. Urban patients had higher rates of substance use and a non-significant trend toward increased 30-day readmission. Neonatal outcomes, including gestational age and birth weight, were comparable. After adjustment for demographic and clinical covariates, rural residence was not independently associated with maternal or neonatal outcomes. Conclusions Within a tertiary care health system, rural and urban patients with HDP experienced similar disease severity, management, and short-term outcomes. These findings suggest that access to specialized obstetric care within a shared health system may reduce geographic disparities in HDP outcomes.