Poster Session 1
Kelly F. Darmawan, MD (she/her/hers)
Maternal Fetal Medicine Fellow
Stanford University
Stanford University, CA, United States
Elizabeth B. Sherwin, MPH
Biostatistician
Stanford University
Palo Alto, California, United States
Brian T. Bateman, MD, MSc
Stanford University
Stanford, California, United States
Danielle M. Panelli, MD, MS (she/her/hers)
Instructor
Stanford University
Palo Alto, California, United States
Sara Siadat
Stanford University
Stanford University, California, United States
Stephanie A. Leonard, PhD (she/her/hers)
Assistant Professor
Stanford University
Palo Alto, California, United States
Medication treatment of chronic hypertension (cHTN) is effective for blood pressure control during and after pregnancy, which is imperative to reduce the risk of adverse outcomes. However, postpartum challenges, including switching to first-line antihypertensive medications that are recommended outside of pregnancy and transitions in primary care providers, may affect the use of antihypertensive medications during this time. We examined patterns of postpartum antihypertensive medication use among people with cHTN requiring medication.
Study Design:
We used the MerativeTM MarketScan® Database of people in the U.S. with private insurance who gave birth between 2008-2022. The study included people with livebirths complicated by cHTN in pregnancy requiring labetalol, nifedipine, or methyldopa for treatment during the first 20 weeks of gestation. We analyzed prescription fills of all antihypertensive medications from 0-6 months postpartum, and examined differences in medication use by comorbidities and in each month postpartum.
Results:
Among 20,168 people with cHTN requiring treatment during pregnancy, 83% received an antihypertensive medication in the first 6 months postpartum and 17% did not (Table 1). Labetalol was the most common medication used (47%), with < 10% use of antihypertensive medications other than nifedipine (23%) or methyldopa (17%). Use of lisinopril was higher in people with diabetes (14%), chronic renal disease (14%), class 3 obesity (11%), or lupus (13%) compared with the overall cohort (9.2%). Use of any medication was 60% in the first month postpartum, then decreased to 41% by six months postpartum (Figure 1).
Conclusion:
In this national, contemporary cohort, 17% of people with cHTN who required treatment early in pregnancy did not receive an antihypertensive medication in the first 6 months postpartum. Use of any medication fell to less than 50% by 2 months postpartum. These findings show the need to improve adherence and transition to appropriate antihypertensive medications postpartum.
