(119) Maternal outcomes in the postpartum period by timing of diagnosis of hypertensive disorder of pregnancy

This cohort study uses data from our institution’s remote blood pressure (BP) management program. Included individuals delivered between 9/2019-4/2024, were enrolled in our remote monitoring program at the time of delivery and had no pre-pregnancy HTN. We compared outpatient BP measures, need for initiation of post-discharge anti-hypertensive medications and care utilization outcomes between individuals with antepartum HDP and those with intrapartum or postpartum HDP first diagnosed during the delivery hospitalization.

Results:

Of 7071 individuals with HDP, 1045 (15%) had new-onset intrapartum or postpartum HDP and 6026 (85%) had antepartum HDP. Compared to those with antepartum HDP, individuals with intrapartum or postpartum HDP had similar rates of severe HTN after hospital discharge (13.9% vs. 13.7%; p=0.87). Overall, individuals with antepartum HDP were more likely to require anti-hypertensive medications at any point  postpartum (46.5% vs. 32.7%; p< 0.001) compared with those with intrapartum or postpartum HDP. However, outpatient initiation of anti-hypertensive medications was equally likely across groups. Rates of ER visits (12.7% vs. 11.4%; p=0.22) and postpartum readmissions (5.1% vs. 5.1%; p=0.98) were similar among individuals with intrapartum and postpartum HDP compared to those with antepartum HDP, respectively.

Conclusion:

Hypertension with onset intrapartum or postpartum is often dismissed or attributed to other etiologies. Our data suggest that individuals with intrapartum and postpartum-onset HDP have similar rates of severe HTN, post-discharge medication initiation and care utilization in the postpartum period as individuals with antepartum HDP and highlights the importance of ongoing BP monitoring after hospital discharge in these individuals.