Longitudinal blood pressure patterns of women with hypertensive disorders of pregnancy: preconception through postpartum

Abstract

Objective

To investigate the longitudinal blood pressure (BP) pattern of women with hypertensive disorders of pregnancy (HDP) preconception through the postpartum day (PPD) 42.

Study Design

A retrospective study of women (≥15 years old) diagnosed with an HDP antenatally or postpartum, who were enrolled prospectively in a postpartum remote BP monitoring program between 3/2017 and 5/2020. BPs were collected from 47-time points: preconception, each trimester, delivery day, and 42 days postpartum. Analysis was conducted utilizing a mixed-effects longitudinal model.

Main outcome measures

Primary outcome was the longitudinal BP patterns. Secondary outcomes were the timing of BP stabilization (BPs < 140/90 mmHg for ≥48 h) and resolution (stabilized without antihypertensive medication use).

Results

Our final analysis included 897 of the 964 eligible women. The peak systolic and diastolic BPs were on PPDs 3, 4, 5, and 5, 6, 7, respectively. Systolic BP fell below the preconception level after PPD15; diastolic BP reached its plateau after PPD17 and remained above the preconception level till PPD42 (p < .001). Postpartum BP peaked with the highest percentage of BP spikes on PPDs 4–7. The median survival times to BP stabilization and resolution were PPDs 11 (95% CI: 10–12) and 23 (95% CI: 21–25), respectively. By PPD42, 91.0% and 74.1% of women achieved BP stabilization and resolution, respectively.

Conclusion

This study data could be used to develop evidence-based recommendations for women with an HDP. Diastolic BPs remaining significantly higher than the preconception level indicates the long-term risk of cardiovascular disease. In our cohort, 26% of women had unresolved hypertension by PPD42, which reinforces the necessity to ensure long-term follow-up.

Keywords:

• Pregnancy
• postpartum
• stabilization
• resolution
• remote blood pressure monitoring

Disclosure statement

No potential conflict of interest was reported by the author(s). The content is solely the responsibility of the authors and does not necessarily represent the official view of the “funding source.”

Additional information

Funding

This project was funded by the University of Wisconsin – Madison Department of Obstetrics & Gynecology Internal Research and Development Grant, grant AAB8291 and by the UnityPoint Health - Meriter Foundation, grant 600 and 637. Also, this study was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR002373.