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

Eric K. Broni; Joana Lopes Perdigao; Nathanael Koelper; Jennifer Lewey; Lisa D. Levine

doi:10.1055/a-2419-9343

American Journal of Perinatology, Table of Contents

Am J Perinatol
DOI: 10.1055/a-2419-9343

Original Article

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

Eric K. Broni

¹Department of Obstetrics and Gynecology, Pregnancy and Perinatal Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

,

Joana Lopes Perdigao

²Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois

,

Nathanael Koelper

³Department of Obstetrics and Gynecology, Women's Health Clinical Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

,

Jennifer Lewey

⁴Department of Medicine, Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

,

Lisa D. Levine

¹Department of Obstetrics and Gynecology, Pregnancy and Perinatal Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

› Author Affiliations

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

Full Text

References

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