Hypertensive Disorders of Pregnancy: Factors Associated with Multiple Postpartum Blood Pressure Visits.

Abstract

Objective: Patients with hypertensive disorders of pregnancy (HDPs) are recommended to attend an early postpartum follow-up visit for blood pressure monitoring. Follow-up frequency for patients with HDPs can vary widely, with some patients requiring multiple office visits. We sought to determine factors associated with multiple postpartum blood pressure visits among patients with HDPs.

Study design: We retrospectively identified patients with HDPs who delivered at our maternity center in 2019 and compared factors between patients who attended a single blood pressure follow-up appointment without requiring further clinical evaluation for hypertension and patients who required multiple postpartum clinical evaluations for persistent hypertension. Univariate logistic regression models were used to identify factors associated with increased odds of having multiple clinically indicated postpartum visits for blood pressure monitoring.

Results: We identified 328 patients with HDPs, of whom 260 (79.3%) attended an initial postpartum blood pressure follow-up appointment and were included in further analyses. Of the 260 patients, 70 (26.9%) had multiple blood pressure visits. Factors associated with multiple blood pressure visits included delivery between 34 and less than 37 weeks of gestation (odds ratio [OR], 3.62; 95% CI, 1.07-12.30), systolic blood pressure before discharge of 140 mm Hg or higher (OR, 5.02; 95% CI, 2.57-9.82), and discharge with blood pressure medication (OR, 3.42; 95% CI, 1.82-6.41).

Conclusion: Patients with HDPs who deliver preterm, have persistent hypertension before discharge, or are discharged with antihypertensive medication require continued close postpartum observation and continuity of care.

Key points: · Postpartum follow-up care for patients with HDPs should be tailored to the patient.. · Preterm delivery, persistence of hypertensive blood pressure at discharge, and discharge with antihypertensive medication are associated with multiple postpartum ambulatory office visits.. · High-risk patients should be diligently monitored with postpartum continuity of care..