Poster Session 4
Chase Calvert, MD (he/him/his)
Resident, Obstetrics & Gynecology, PGY4
Dell Medical School
Austin, TX, United States
Rajesh Reddy, MD
Fellow
Dell Medical School
Austin, Texas, United States
Molly Singer, MD
Assistant Professor
Dell Medical School, University of Texas at Austin
Austin, Texas, United States
Jeny Ghartey, DO, MS
Maternal Medical Director
University of Texas at Austin
Austin, Texas, United States
Lorie M. Harper, MD, MSCI (she/her/hers)
Associate Professor
Dell Medical School
Austin, Texas, United States
Hypertensive disease of pregnancy (HDP) is a leading cause of maternal postpartum readmission. While diuretics have been shown to reduce postpartum hypertension in women with HDP, their effectiveness in preventing postpartum readmission remains unclear. We performed a meta-analysis and systematic review to evaluate the impact of diuretic use on postpartum readmission rates in patients with HDP.
Study Design:
We conducted a comprehensive search on PubMed, MEDLINE, Web of Science, PROSPERO, Cochrane Library, and ClinicalTrials.gov using a combination of key terms. Studies were included if they were published after 1995 and comprised clinical trials or observational cohorts. Eligible studies compared diuretic treatment to non-diuretic-based or no treatment in the postpartum period for patients with HDP. The primary outcome measured was readmission rates.
Results:
Six studies, encompassing a total of 2,893 patients, were included. Five studies utilized loop diuretics (furosemide [4] and torsemide [1]), and one utilized a thiazide. The pooled odds ratio (OR) for readmission with any diuretic use was 1.35 (95% CI: 0.66 to 2.75). Visual inspection of the funnel plot revealed some asymmetry, suggesting that smaller studies showing positive results (i.e., those indicating a beneficial effect of diuretics on reducing readmission rates) might be missing. This asymmetry indicates potential publication bias. The variability among the studies was moderate (I² = 44.8%, P = 0.107). Metaregression analysis highlighted that the type of diuretic used had a significant impact on the results. Specifically, secondary analyses focusing only on studies that used loop diuretics (furosemide and torsemide) consistently showed a trend towards increased readmission rates.
Conclusion: Diuretic use in postpartum patients with HDP is not associated with decreases in readmission. Potential publication bias and the significant impact of diuretic type, particularly loop diuretics, on readmission rates highlight the need for targeted, large-scale prospective studies to accurately assess their role in managing postpartum hypertension.
