Maternal age linked to readmission risk in women with preeclampsia, gestational hypertension
Key takeaways:
- Risk for postpartum readmission for preeclampsia rose with maternal age.
- Proteinuria presence, more hypertension medications at discharge and longer initial hospitalization were linked to decreased readmission.
BALTIMORE — Maternal age in women with preeclampsia or gestational hypertension with severe features was associated with higher postpartum readmission risk, while intensive hypertension treatment at initial admission may limit risk.
“This project was started after observing several readmissions for the development of severe preeclampsia in the postpartum period in our patient population. Less is known regarding risk factors for postpartum readmission for preeclampsia,” Mary N. Nienow Birch, MD, third year obstetrician-gynecologist resident at the University of Illinois, Chicago, said during the presentation at the ACOG Annual Clinical & Scientific Meeting. “Yet we witnessed the financial, emotional and psychological burden of being separated from friends, from family and patients’ neonates in the postpartum period, along with the critical importance of blood pressure control and treatment in reducing the risk of eclampsia, stroke and myocardial infarction, all of which we know to be more likely to occur in the postpartum period.”
Researchers identified 747 women who were diagnosed antenatally or postnatally with preeclampsia or gestational hypertension with severe features between 2010 and 2019. Researchers obtained data on background and pregnancy characteristics through electronic medical records and utilized the Chicago Health Atlas to assign ZIP code-based socioeconomic hardship and education scoring. Using this information, researchers evaluated whether individual, pregnancy and neighborhood factors predicted hospital readmission odds. This involved two models: model 1 included maternal age, BMI, fetal growth restriction, urine protein, preterm delivery and cesarean section; and model 2 added neighborhood factors, number of hypertensive medications at hospital discharge and length of hospital stay.
Overall, 14.8% of women were diagnosed with preeclampsia with severe features (mean age, 31.83 years) on postnatal hospital readmission.
In model 1, researchers noted that older age of almost 32 years was associated with an increased hospital readmission risk (adjusted OR = 1.07; 95% CI, 1.03-1.11). Presence of proteinuria (aOR = 0.38; 95% CI, 0.24-0.61) and preterm delivery (aOR = 0.52; 95% CI, 0.3-0.91) were both associated with decreased hospital readmission odds in this patient population.
In model 2, older age remained significantly associated with an increased hospital readmission risk (aOR = 1.09; 95% CI, 1.04-1.14). However, proteinuria presence (aOR = 0.24; 95% CI, 0.12-0.45), more hypertension medications received at hospital discharge (aOR = 0.44; 95% CI, 0.24-0.82) and longer initial hospital stay (aOR = 0.6; 95% CI, 0.4-0.92) were all associated with decreased hospital readmission odds.
Hardship index score was not predictive for readmission for postpartum preeclampsia. Researchers observed no other studied factors that were also associated with hospital readmission in this patient population.
“Future directions for research in this area include exploring how COVID restrictions may have impacted rates of readmission with postpartum preeclampsia, and exploring other ways these hardship index scores may be incorporated into future studies,” Nienow Birch said.
Reference:
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Nienow Birch MN, et al. Factors Associated with Readmission for Postpartum Preeclampsia [ID: 1378401]. Presented at: ACOG Annual Clinical & Scientific Meeting; May 19-21, 2023; Baltimore.
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