Pregnancy hypertension was an increasing public health issue contributing to maternal morbidity, death, and future cardiovascular disease risk. Researchers described current trends in new-onset hypertensive disorders of pregnancy in the United States, based on recognized rural-urban variations in maternal cardiovascular health. Using the Centers for Disease Control and Prevention Natality Database, researchers conducted a serial, cross-sectional analysis of 51,685,525 live births to persons aged 15 to 44 from 2007 to 2019. Researchers included gestational hypertension and preeclampsia/eclampsia in people without chronic hypertension and computed the age-adjusted incidence (95% CI) per 1,000 live births overall and by urbanization status (rural or urban). Researchers used Joinpoint software to find inflection points and determine the rate of change. Researchers calculated rate ratios to examine the relative incidence in rural and urban areas. New start hypertensive disorders of pregnancy increased in both rural (48.6 [48.0–49.2] to 83.9 [83.1–84.7]) and urban (37.0 [36.8–37.2] to 77.2 [76.8–77.6]) areas from 2007 to 2019. After 2014, the annual increase in new-onset hypertensive disorders of pregnancy was faster, with metropolitan areas accelerating faster than rural areas. The incidence of new-onset hypertensive disorders of pregnancy in rural and urban areas dropped from 1.31 (1.30–1.33) in 2007 to 1.09 (1.08–1.10) in 2019. From 2007 to 2019, the rate of new-onset hypertensive disorders of pregnancy doubled, with significant rural-urban disparities underlining the need for focused interventions to enhance the health of pregnant women and their kids.