Postpartum hypertension may be missed due to limited postpartum follow-up

November 15, 2022

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Data from a large safety-net hospital show that postpartum hypertension occurs in 1 in 10 patients within the first year after birth, with nearly half resulting from hospitalization for childbirth. , the researchers report.

“Our findings have implications for postpartum care, especially among women with no history of hypertension.” Dr. Samantha Parker An assistant professor of epidemiology at the Boston University School of Public Health said in a press release: “We were surprised at the number of cases found after more than 6 weeks postpartum. Monitoring during this period may reduce severe postpartum and long-term cardiovascular complications.”

A graphical depiction of the data presented in the article

Data are from Parker SE et al. high blood pressure2022; doi:10.1161/HYPERTENSIONAHA.122.19275.

In a retrospective study, Parker and colleagues analyzed medical record data from 3,925 deliveries from 2016 to 2018 at a large safety-net hospital in an urban area of ​​Boston. All blood pressure readings up to . Within the cohort, 54% of the women were black and 18% were Hispanic. Women with chronic hypertension or gestational hypertension were excluded. The investigators defined de novo postpartum hypertension as two separate blood pressure measurements showing a systolic blood pressure of 140 mm Hg or higher and a diastolic blood pressure of 90 mm Hg or higher at least 48 hours after delivery. Severe de novo postpartum hypertension was defined as systolic blood pressure ≥160 mm Hg and diastolic blood pressure ≥110 mm Hg. Researchers examined the timing of diagnosis using risk factors individually and in combination.

The survey results are Hypertension.

Among 2,465 women with no history of hypertension, 12.1% (n = 298) developed de novo postpartum hypertension, of which 17.1% had severe de novo postpartum hypertension.

Compared with women without de novo postpartum hypertension, those who developed it were older than 35 years (36.2% vs. 22.8%), non-Hispanic blacks (62.4% vs. 52.7%), and were more likely to deliver by cesarean section. was highly sexual. (60.7% vs 33.9%). A woman with de novo postpartum hypertension was more likely to have had at least two previous pregnancies and to have her BMI value of 30 kg/m before or in early pregnancy.2 or higher and is a current smoker or illicit drug user.

Most cases of de novo postpartum hypertension were diagnosed during delivery admission (54.7%). A further 23.2% of cases were diagnosed between delivery and 6 weeks postpartum, and 22.1% were diagnosed 6 weeks postpartum.

Samantha Parker

“The inclusion of BP data collected over the first year after birth allowed us to explain the distribution of time of diagnosis,” the researchers wrote. , 43% of de novo postpartum hypertension were identified from blood pressure readings obtained at a series of clinical touchpoints after delivery and about half of these were captured 6 weeks postpartum. , suggesting that monitoring blood pressure during this period may benefit selected patients.”

Parker noted that a better understanding of hypertension beyond 6 weeks postpartum may provide insight into racial disparities in maternal health.

“Previous studies have shown that new-onset hypertension after childbirth may be up to 2.5 times more common in non-Hispanic black women compared to white women.

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