Maternal postpartum six-week check and short-term health outcomes for women with hypertensive disorders in pregnancy: An observational study using the Clinical Practice Research Datalink (CPRD)

Abstract

Introduction

In the UK, in addition to the recommended blood pressure check, women with hypertensive disorders of pregnancy are offered a postpartum six-week check (SWC) with either a specialist or general practitioner. We aimed to describe the prevalence and disparities in the provision of SWC, and describe short-term postpartum outcomes among women with hypertensive disorders of pregnancy by SWC status.

Material and Methods

Data were from the UK Clinical Practice Research Datalink GOLD for women aged 15–49 years at childbirth in 2000–2018, who were diagnosed with hypertensive disorders of pregnancy, and were registered for ≥12 months postpartum. Trends in SWC prevalence and differences in characteristics and short-term postpartum outcomes of women by SWC status were described. Multivariable modified Poisson regression was used to compute risk ratio of a SWC for severe hypertensive disorders of pregnancy.

Results

Of 30 483 women, 61.4% had a SWC. The proportion of women who received a SWC check was highest in 2007 (66.8%) but subsequently decreased. Women were less likely to have a SWC record if they were younger, of a minoritised ethnicity, living in more deprived areas, were multiparous, had severe hypertensive disorders of pregnancy, preterm birth, caesarean birth, or had a low birthweight baby. Compared to women who did not have a SWC, a higher proportion of women with SWC had their blood pressure recorded (SWC 47.4%, no SWC 39.9%), and had a diagnosis of postpartum depression (SWC 13.6%, no SWC 11.1%). There were no substantial differences in other short-term postpartum outcomes by SWC status.

Conclusions

There may be missed opportunities in postpartum care among women with hypertensive disorders of pregnancy. Our findings highlight the need to ensure that general postpartum care is not overlooked in women with specific morbidities in pregnancy.