Does Timing of Diagnosis of Hypertensive Disorders of Pregnancy Impact Blood Pressure Resolution?

Abstract

Objective Hypertensive disorders of pregnancy (HDP) can be diagnosed prior to labor, during labor, or postpartum. We evaluated whether the timing of HDP diagnosis impacts postpartum blood pressure (BP) outcomes.

Study Design Secondary analysis of 384 patients with HDP from a trial evaluating furosemide use on BP outcomes. The timing of HDP diagnosis was categorized into diagnosis in the antepartum period, prior to labor versus diagnosis peripartum (during labor or first day of postpartum). Outcomes included time to resolution of hypertension and persistent hypertension 7 days' postpartum. Logistic and Cox regression models were used.

Results Patients diagnosed in the peripartum period had a shorter median time to postpartum BP resolution after adjusting for severity of HDP, mode of delivery, and furosemide use (5.5 vs. 6.5 days, adjusted hazard ratio: 1.18, 95% confidence interval [1.11–1.25]).

Conclusion Patients diagnosed with HDP in the peripartum period experience a faster BP resolution than those diagnosed in the antepartum period.

Key Points

• HDP can be diagnosed before and during labor and postpartum.

• The timing of HDP diagnosis may have different implications for postpartum BP outcomes.

• Patients diagnosed with HDP in the peripartum period experienced a 24-hour shorter time to BP resolution.

• Timing of HDP diagnosis may provide an added window of opportunity to augment existing modalities of managing postpartum hypertension and related cardiovascular disease complications.

Keywords

hypertensive disorders of pregnancy - peripartum hypertension - postpartum hypertension - labor - timing of HDP diagnosis

Data Availability Statement

Due to patient identifiers and protected health information, there are restrictions on sharing the actual database used for this analysis. The availability of the datasets presented in this article is therefore subject to the University of Pennsylvania Institutional Review Board approval. The findings of this study should be easily reproducible through the methods described.

Authors' Contributions

E.K.B. designed the study, analyzed, and interpreted the data, wrote the first draft of the manuscript, and critically revised the manuscript for intellectual content, N.K. designed the study, analyzed, and interpreted the data and critically revised the manuscript for intellectual content. J.L.P. designed the study, collected the data, interpreted the data, and critically revised the manuscript for intellectual content. J.L. interpreted the data and critically revised the manuscript for intellectual content. L.D.L. designed the study, interpreted the data, and critically revised the manuscript for intellectual content.

Publication History

Received: 21 May 2024

Accepted: 20 September 2024

Accepted Manuscript online:
24 September 2024

Article published online:
10 October 2024

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