(516) Postpartum healthcare utilization and morbidity amongst diabetic versus non-diabetic individuals in remote hypertension program

Individuals with diabetes (gestational or pregestational) are at increased risk of adverse outcomes, particularly in the setting of chronic hypertension (HTN) or new-onset HTN in pregnancy. Though remote self-measured blood pressure (SMBP) monitoring programs may reduce rates of HTN-related hospital readmission, emergency department (ED) presentations, or severe maternal morbidity (SMM), it is unclear whether the extent of this reduction differs between those with and without diabetes. We aimed to compare outcomes between postpartum patients in our remote SMBP program with versus without diabetes.

Study Design:

Postpartum patients with HTN at our tertiary care hospital are offered enrollment in our remote SMBP program, which includes BP monitoring for 6 weeks postpartum. For this analysis, participants were stratified by presence or absence of diabetes (pregestational or gestational). Those with unknown diabetes status were excluded. The primary outcome was a composite of postpartum readmission or ED presentation for HTN within 30 days of delivery hospitalization. Secondary outcomes included HTN-related SMM. A generalized linear model was used to estimate relative risks (RR) after adjustment for differences in demographic, obstetric, and medical conditions from table 1.

Results: Of 2003 participants in the SMBP program, 17.2% had diabetes. Compared to those without, those with diabetes were older, less likely to identify as White, less likely to have gestational but more likely to have chronic hypertension, more likely to be delivered via cesarean, and had a lower median gestational age at delivery (Table 1). After adjusting for these factors, there was no difference in the risk of the composite outcome of HTN-related postpartum readmission or ED presentation between those with and without diabetes [15.9% versus 16.6%; adjusted RR 0.9 (0.7, 1.2)]. Similarly, there were no differences in secondary outcomes (Table 2).

Conclusion: In our remote SMBP program for postpartum patients with HTN, both unplanned HTN-related healthcare utilization and SMM were similar between those with and without diabetes.