Antihypertensive therapy and unplanned maternal postpartum healthcare utilization in patients with mild chronic hypertension

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2024-10-18 DOI:10.1016/j.ajogmf.2024.101525

Anna Palatnik MD , Justin Leach PhD , Lorie Harper MD, MSCI , Baha Sibai MD , Sherri Longo MD , Lorraine Dugoff MD , Kirsten Lawrence MD, MSCE , Brenna L. Hughes MD, MSc , Joseph Bell MD , Rodney K. Edwards MD, MS , Kelly S. Gibson MD , Caroline Rouse MD , Lauren Plante MD , Kara K. Hoppe DO, MS , Janelle Foroutan MD , Methodius Tuuli MD , Hyagriv N. Simhan MD, MS , Heather Frey MD, MSCI , Todd Rosen MD , Torri D. Metz MD, MS , Alan T.N. Tita MD, PhD

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引用次数: 0

Abstract

Objective

To test whether treatment of mild chronic hypertension (CHTN) in pregnancy is associated with lower rates of unplanned maternal healthcare utilization postpartum.

Methods

This was a secondary analysis of the CHTN and pregnancy study, a prospective, open-label, pragmatic, multicenter, randomized treatment trial of pregnant people with mild CHTN. All patients with a postpartum follow-up assessment were included. The primary outcome was unplanned healthcare utilization, defined as unplanned postpartum clinic visits, Emergency Department (ED) or triage visits, or unplanned hospital admissions within 6 weeks postpartum. Differences in outcomes were compared between study groups (Active Group: blood pressure goal of<140/90 mm Hg, and Control Group: blood pressure goal of <160/105 mm Hg), and factors associated with outcomes were examined using logistic regression.

Results

A total of 2293 patients were included with 1157 (50.5%) in the active group and 1136 (49.5%) in the control group. Rates of unplanned maternal postpartum healthcare utilization did not differ between treatment and control groups, (20.2% vs 23.3%, P=.07, aOR 0.84, 95% CI 0.69–1.03). However, ED or triage/maternity evaluation unit visits were significantly lower in the Active group (10.2% vs 13.2%, P=.03, aOR 0.76, 95% 0.58–0.99). Higher BMI at enrollment and cesarean delivery were associated with higher odds of unplanned postpartum healthcare utilization.

Conclusion

While treatment of mild CHTN during pregnancy and postpartum was not significantly associated with overall unplanned healthcare resource utilization, it was associated with lower rates of postpartum ED and triage visits.

查看原文本刊更多论文

轻度慢性高血压患者的抗高血压治疗和产后非计划使用医疗服务的情况。

目的检验妊娠期轻度慢性高血压（CHTN）的治疗是否与降低产后孕产妇非计划医疗使用率有关：这是一项针对妊娠期轻度慢性高血压患者的前瞻性、开放标签、实用性、多中心、随机治疗试验--妊娠期轻度慢性高血压（CHTN）研究（CHAP）的二次分析。所有接受产后随访评估的患者都被纳入其中。主要研究结果是产后六周内的非计划医疗利用率，即产后非计划门诊就诊、急诊或分诊就诊或非计划住院。比较了研究组之间的结果差异（积极组：血压达标）：共纳入 2,293 名患者，其中积极组 1,157 人（50.5%），对照组 1,136 人（49.5%）。治疗组和对照组的产妇产后非计划保健使用率没有差异（20.2% vs 23.3%，P=0.07，aOR 0.84，95% CI 0.69-1.03）。但是，积极组的急诊室或分诊/产科评估单位就诊率明显较低（10.2% vs 13.2%，P=0.03，aOR 0.76，95% 0.58-0.99）。入院时较高的体重指数和剖宫产与较高的产后非计划医疗使用率有关：虽然孕期和产后轻度 CHTN 治疗与整体计划外医疗资源利用率无显著相关性，但与产后急诊室就诊率和分诊率较低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.