Limited postpartum follow-up may miss hypertension after delivery
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Data from a large safety-net hospital show de novo postpartum hypertension occurs in one of 10 patients in the year after delivery, with nearly half from the delivery hospitalization, researchers reported.
“The findings of our study have implications for postpartum care, particularly among women without a history of high blood pressure,” Samantha Parker, PhD, an assistant professor of epidemiology at Boston University School of Public Health, said in a press release. “We were surprised at the number of cases captured more than 6 weeks after delivery, a period that falls well outside of routine postpartum follow-up. Monitoring during this period could mitigate severe postpartum and long-term cardiovascular complications.”
In a retrospective study, Parker and colleagues analyzed medical records data from 3,925 deliveries from 2016 to 2018 at a large urban safety-net hospital in Boston, assessing all BP measures during pregnancy through 12 months postpartum. Within the cohort, 54% of women were Black and 18% were Hispanic. Women with chronic hypertension or hypertensive disorders of pregnancy were excluded. Researchers defined de novo postpartum hypertension as two separate BP readings with systolic BP of 140 mm Hg or greater and diastolic BP of 90 mm Hg or greater at least 48 hours after delivery. Severe de novo postpartum hypertension was defined as systolic BP of 160 mm Hg or greater and diastolic BP of 110 mm Hg or greater. Researchers examined risk factors individually and in combination and timing of diagnosis.
The findings were published in Hypertension.
Among the 2,465 women without a history of hypertension, 12.1% (n = 298) developed de novo postpartum hypertension, 17.1% of whom had severe de novo postpartum hypertension.
Compared with women without de novo postpartum hypertension, women who developed it were more likely to be aged 35 years or older (36.2% vs. 22.8%), be non-Hispanic Black (62.4% vs. 52.7%) and deliver via cesarean section (60.7% vs. 33.9%). Women with de novo postpartum hypertension were also more likely to have at least two prior births, have prepregnancy or early pregnancy BMI values of 30 kg/m2 or greater and be current smokers or users of illicit drugs.
Most cases of de novo postpartum hypertension were diagnosed during the delivery hospitalization (54.7%). An additional 23.2% of cases were diagnosed between delivery discharge and 6 weeks postpartum and 22.1% were diagnosed after 6 weeks postpartum.
“Due to our inclusion of BP data collected through the entire year postpartum, we were able to describe the distribution of time of diagnosis,” the researchers wrote. “While the majority of postpartum hypertension was documented before discharge from the delivery hospitalization, 43% of de novo postpartum hypertension was identified from BP measurements obtained at an array of clinical touchpoints after delivery discharge. Approximately half of these were captured after 6 weeks postpartum, which suggests that monitoring of BP during this time may benefit selected patients.”
Parker noted that understanding more about high BP beyond 6 weeks after delivery may provide insight into racial disparities in maternal health.
“Previous research has shown that new-onset hypertension after childbirth may be up to 2.5 times more common among non-Hispanic Black women compared to white women,” Parker said in the release.
Reference:
- Limited postpartum follow-up may miss high blood pressure in 1 in 10 new moms. https://newsroom.heart.org/news/limited-postpartum-follow-up-may-miss-high-blood-pressure-in-1-in-10-new-moms. Published Nov. 15, 2022. Accessed Nov. 15, 2022.
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