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Am J Perinatol 2023; 40(14): 1579-1584
DOI: 10.1055/s-0041-1739291
Original Article

Characteristics of Patients Who Attend the 7- to 10-Day Postpartum Visit for Blood Pressure Evaluation

Maggie Tallmadge
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Mary Christine Livergood
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Alina Tvina
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Sarah Evans
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Jennifer McIntosh 
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Anna Palatnik 
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
2   Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to assess maternal characteristics that predict attendance of postpartum blood pressure evaluation in patients with hypertensive disorders of pregnancy (HDP).

Study Design A retrospective case–control study of patients with HDP delivering at a single academic institution (2014–2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of the 7- to 10-day postpartum blood pressure evaluation.

Results Of the 1,041 patients included in the analysis, 603 (57.9%) attended the 7- to 10-day postpartum blood pressure check. Maternal sociodemographic, clinical, and obstetric factors differed significantly between patients who attended the postpartum blood pressure visit and those who did not. In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild-range blood pressures on day of discharge, and initiation of antihypertensive medication were associated with attendance of the 7- to 10-day postpartum visit. In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (adjusted odds ratio [aOR]: 1.58; 95% confidence interval: [CI]: 1.14–2.17), severe HDP (aOR: 1.94, 95% CI: 1.44–2.61), and cesarean birth (aOR: 1.92, 95% CI: 1.43–2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR: 0.68, 95% CI: 0.47–0.97), and public insurance (aOR: 0.65, 95% CI: 0.45–0.93) compared with private insurance.

Conclusion Clinical factors such as nulliparity, severe HDP, and cesarean birth were associated with higher rates of postpartum blood pressure evaluation attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance.

Key Points

  • A total of 57.9% of patients with HDP attended in person postpartum blood pressure check.

  • Nulliparity, severe features of HDP, and cesarean birth were associated with higher rates of attendance.

  • Non-Hispanic black race and ethnicity and public insurance were associated with lower attendance.

Keywords

hypertensive disorders of pregnancy - gestational hypertension - preeclampsia - postpartum follow-up - blood pressure

Note

Each author has indicated that she has met the journal's requirements for authorship. This study was presented as a poster at the 41st Annual Meeting of the Society for Maternal-Fetal Medicine, Virtual meeting, January 25–30, 2021.




Publication History

Received: 11 January 2021

Accepted: 04 October 2021

Article published online:
14 November 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Mogos MF, Salemi JL, Spooner KK, McFarlin BL, Salihu HH. Hypertensive disorders of pregnancy and postpartum readmission in the United States: national surveillance of the revolving door. J Hypertens 2018; 36 (03) 608-618
    CrossrefPubMedGoogle Scholar
  • 2 Shah S, Gupta A. Hypertensive disorders of pregnancy. Cardiol Clin 2019; 37 (03) 345-354
    CrossrefPubMedGoogle Scholar
  • 3 Gestational Hypertension and Preeclampsia. Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135 (06) e237-e260
    CrossrefPubMedGoogle Scholar
  • 4 Yattinamani BP, Guruvare S, Rai L. Postpartum recovery trends in women with hypertensive disorders of pregnancy. J Clin Outcomes Manag 2017; 24 (02) 66-70
    PubMedGoogle Scholar
  • 5 Bramham K, Nelson-Piercy C, Brown MJ, Chappell LC. Postpartum management of hypertension. BMJ 2013; 346: f894
    CrossrefPubMedGoogle Scholar
  • 6 Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol 2017; 130 (02) 366-373
    CrossrefPubMedGoogle Scholar
  • 7 Too G, Wen T, Boehme AK. et al. Timing and risk factors of postpartum stroke. Obstet Gynecol 2018; 131 (01) 70-78
    CrossrefPubMedGoogle Scholar
  • 8 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019; 133 (01) e26-e50
    CrossrefPubMedGoogle Scholar
  • 9 Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; Nov; 122 (05) 1122-1131
    CrossrefPubMedGoogle Scholar
  • 10 Hirshberg A, Downes K, Srinivas S. Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial. BMJ Qual Saf 2018; 27 (11) 871-877
    CrossrefPubMedGoogle Scholar
  • 11 Romagano MP, Williams SF, Apuzzio JJ, Sachdev D, Flint M, Gittens-Williams L. Factors associated with attendance at the postpartum blood pressure visit in pregnancies complicated by hypertension. Pregnancy Hypertens 2020; 22: 216-219
    CrossrefPubMedGoogle Scholar
  • 12 Lewey J, Levine LD, Yang L, Triebwasser JE, Groeneveld PW. Patterns of postpartum ambulatory care follow-up care among women with hypertensive disorders of pregnancy. J Am Heart Assoc 2020; 9 (17) e016357
    CrossrefPubMedGoogle Scholar
  • 13 Levine LD, Nkonde-Price C, Limaye M, Srinivas SK. Factors associated with postpartum follow-up and persistent hypertension among women with severe preeclampsia. J Perinatol 2016; 36 (12) 1079-1082
    CrossrefPubMedGoogle Scholar
  • 14 Wu P, Jordan KP, Chew-Graham CA. et al. Temporal trends in pregnancy-associated stroke and its outcomes among women with hypertensive disorders of pregnancy. J Am Heart Assoc 2020; 9 (15) e016182
    CrossrefPubMedGoogle Scholar
  • 15 Al-Safi Z, Imudia AN, Filetti LC, Hobson DT, Bahado-Singh RO, Awonuga AO. Delayed postpartum preeclampsia and eclampsia: demographics, clinical course, and complications. Obstet Gynecol 2011; 118 (05) 1102-1107
    CrossrefPubMedGoogle Scholar
  • 16 Nizamuddin J, Gupta A, Patel V. et al. Hypertensive diseases of pregnancy increase risk of readmission with heart failure: a national readmissions database study. Mayo Clin Proc 2019; 94 (05) 811-819
    CrossrefPubMedGoogle Scholar
  • 17 Rodin D, Silow-Carroll S, Cross-Barnet C, Courtot B, Hill I. Strategies to promote postpartum visit attendance among medicaid participants. J Womens Health (Larchmt) 2019; 28 (09) 1246-1253
    CrossrefPubMedGoogle Scholar
  • 18 Henderson V, Stumbras K, Caskey R, Haider S, Rankin K, Handler A. Understanding factors associated with postpartum visit attendance and contraception choices: listening to low-income postpartum women and health care providers. Matern Child Health J 2016; 20 (Suppl. 01) 132-143
    CrossrefPubMedGoogle Scholar
  • 19 DiBari JN, Yu SM, Chao SM, Lu MC. Use of postpartum care: predictors and barriers. J Pregnancy 2014; 2014: 530769
    CrossrefPubMedGoogle Scholar
  • 20 Hauspurg A, Lemon LS, Quinn BA. et al. A postpartum remote hypertension monitoring protocol implemented at the hospital level. Obstet Gynecol 2019; 134 (04) 685-691
    CrossrefPubMedGoogle Scholar
  • 21 Hoppe KK, Williams M, Thomas N. et al. Telehealth with remote blood pressure monitoring for postpartum hypertension: a prospective single-cohort feasibility study. Pregnancy Hypertens 2019; 15: 171-176
    CrossrefPubMedGoogle Scholar