De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital

Abstract

Background: Postpartum hypertension can be persistent, following a pregnancy complicated by hypertension, or new onset (de novo), following a normotensive pregnancy. The aim of this study is to estimate the incidence and identify risk factors for de novo postpartum hypertension (dn-PPHTN) among a diverse safety-net hospital population. Methods: We conducted a retrospective cohort study of 3925 deliveries from 2016 to 2018. All blood pressure (BP) measures during pregnancy through 12 months postpartum were extracted from medical records. Patients with chronic hypertension or hypertensive disorders of pregnancy were excluded. dn-PPHTN was defined as 2 separate BP readings with systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg at least 48 hours after delivery. Severe dn-PPHTN was defined as systolic BP ≥160 and diastolic BP ≥110. We examined risk factors individually and in combination and timing of diagnosis. Results: Among the 2465 patients without a history of hypertension, 12.1% (n=298) developed dn-PPHTN; 17.1% of whom had severe dn-PPHTN (n=51). Compared to those without dn-PPHTN; cases were more likely to be ≥35 years, delivered via cesarean, or be current or former smokers. Patients with all of these characteristics had a 29% risk of developing dn-PPHTN, which was elevated among non-Hispanic Black patients (36%). Approximately 22% of cases were diagnosed after 6 weeks postpartum. Conclusions: More than 1 in 10 patients with normotensive pregnancies experience dn-PPHTN in the year after delivery. Opportunities to monitor and manage patients at the highest risk of dn-PPHTN throughout the entire year postpartum could mitigate cardiovascular related maternal morbidity.

Angiogenic markers and maternal echocardiographic indices in women with hypertensive disorders of pregnancy

“…Although it is well known that women with history of HDP have an increased risk of CVD 22 , the vast majority of postpartum CVD still occur in women without HDP. For instance, more than 1 in 10 patients were found to be hypertensive in the first year postpartum after a normotensive pregnancy 44 . As pregnancy offers a window of opportunity for CVD screening in young adult women, vascular markers in isolation or combined with TTE assessment, could help identify women at risk of future CVD 36 .…”

Postpartum Remote Blood Pressure Monitoring Using a Mobile App in Women with a Hypertensive Disorder of Pregnancy

“…BP peaks between 3 and 6 days postpartum for those who experienced a normotensive pregnancy as well as for those who experienced a hypertensive disorder (Powles & Ghandi, 2017). Approximately 10% of women with normal BP during pregnancy develop hypertension in the first 6 weeks following birth (Parker et al, 2023). New-onset postpartum hypertension is often underestimated and underdiagnosed.…”

Postpartum remote home blood pressure monitoring: the new frontier

“… 41 De novo, or delayed, postpartum preeclampsia is defined as new development of preeclampsia 48 hours to 6 weeks postpartum, and is an important contributor to hypertension-related morbidity. 41 This abnormal rise in blood pressure in a previously normotensive patient affects 1 in 10 women 42 and has been shown to cause worse morbidity and mortality than hypertension diagnosed during the antepartum and intrapartum periods. Therefore, adoption of patient-driven blood pressure monitoring may successfully allow for earlier recognition and treatment of de novo postpartum hypertension with subsequent improvement in outcomes.…”