Limited postpartum follow-up may miss high blood pressure in 1 in 10 new moms
In an analysis of more than 2,400 women, about 1 in 10 without a history of blood pressure issues were diagnosed with high blood pressure in the year after childbirth, according to a research article published today in Hypertension, an American Heart Association journal. Nearly a quarter of the women were diagnosed more than six weeks after delivery — a time when many women have stopped receiving follow-up care.
“The findings of our study have implications for postpartum care, particularly among women without a history of high blood pressure,” said lead study author Samantha Parker, Ph.D., an assistant professor of epidemiology at Boston University School of Public Health. “We were surprised at the number of cases captured more than six weeks after delivery, a period that falls well outside of routine postpartum follow-up. Monitoring during this period could mitigate severe postpartum and long-term cardiovascular complications.”
High blood pressure after childbirth, called postpartum hypertension, is typically discovered within six weeks of delivery — either immediately after childbirth or during a woman’s last postpartum clinic visit at 4-6 weeks after delivery. Data is limited for the time beyond 6 weeks since most studies have relied on blood pressure measurements during delivery or hospitalization, which includes just the first few days postpartum and captures only the most severe cases.
In severe cases, postpartum hypertension is associated with life-threatening complications, including stroke, heart failure, kidney failure and more. And, while it is well established that women with high blood pressure before or during pregnancy are at risk for cardiovascular disease later in life, very few studies have assessed cardiovascular risk for women who develop high blood pressure for the first time, or new-onset hypertension, after childbirth.
“Understanding more about high blood pressure beyond 6 weeks after delivery may provide insight into the alarming racial disparities in maternal health,” said Parker. “Previous research has shown that new-onset hypertension after childbirth may be up to 2.5 times more common among non-Hispanic Black women compared to white women.”
The study aimed to estimate how common new-onset postpartum hypertension is among a racially diverse population. The researchers also wanted to determine contributing factors so healthcare professionals can identify pregnant patients at risk. Researchers evaluated medical records from 8,374 deliveries with a pregnancy length of at least 20 weeks from 2016-2018 at Boston Medical Center, a large, central, urban safety-net hospital in Boston. Safety-net hospitals tend to have a higher percentage of patients with low household income, and they are more likely to have no health insurance or rely on Medicaid for health care coverage.
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