(1031) Incidence And Risk Factors For Postpartum Hypertension In LMICs: A Large Prospective Multi-Country Cohort Study

Objective: To identify the incidence and risk factors associated with elevated blood pressure at 6 weeks postpartum among women in Ghana, Kenya, India, Pakistan, and Zambia.

Study

Design: We report findings from the Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRISMA) prospective multi-country pregnancy cohort in Kenya, Ghana, Zambia, Pakistan, and India. Hypertension (HTN) is defined as blood pressure (BP) greater than 140/90. We excluded participants with known chronic hypertension or elevated BP prior to 20 gestational weeks. We used descriptive statistics to report the incidence of postpartum hypertension overall and by region. We performed multivariable Poisson regression with robust variance to describe the relationship between risk factors and postpartum hypertension with relative risks and 95% confidence intervals.

Results: A total of 3858/4358 (89%) participants had at least 1 BP measured at the 6-week postpartum visit and were included in the analysis. The incidence of high BP postpartum differed by region, with 2.7% of participants in South Asia and 7.3% in Africa meeting criteria. Overall, 50/251 (19.9%) participants with hypertensive diseases of pregnancy had persistent elevated BP at 6 weeks postpartum, compared to 4% new onset high BP at 6 weeks postpartum among those who did not have any hypertensive disorders of pregnancy. Factors associated with high BP postpartum included maternal age (aRR 1.10, 95% CI 1.08, 1.13), early pregnancy BMI ≥ 30 (aRR 2.24, 95% CI 1.58, 3.18), and a diagnosis of gestational hypertension or preeclampsia during the current pregnancy (aRR 4.20, 95% CI 2.9, 5.9; aRR 4.49 95% CI 2.85, 7.07, respectively). Participants with HIV infection were less likely to have elevated blood pressure (aRR 0.46 95% CI 0.25, 0.83).

Conclusion: This study demonstrates a high incidence of elevated blood pressure postpartum with notable differences by region. These findings underscore the need for robust follow-up at and beyond 6 weeks after delivery and linkages to primary care for women with persistent hypertension.