Postpartum blood pressure patterns in severe preeclampsia and normotensive pregnant women following abdominal deliveries: a cohort study

Abstract

Objective: To determine blood pressure (BP) patterns in the immediate postpartum period in preeclampsia with severe features (sPE) and normotensive pregnant women who had cesarean deliveries (CD).

Study design: The BP levels of two groups comprising 50 sPE and 90 normotensive pregnant women who had CD were measured before delivery and on days 0–3 postpartum at four time points (05:00, 08:00, 14:00, and 22:00). Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF) were measured in the maternal serum ≤48 h before delivery.

Results: Antihypertensive therapy was administered to 98, 96, 82, 78, and 56% of sPE antepartum and on postpartum days 0–3, respectively. De novo postpartum hypertension (BP ≥ 140/90 mmHg) occurred in 24.4% (22/90) of the normotensive group but only one required antihypertensive therapy. The occurrence of de novo postpartum hypertension was associated with maternal weight before delivery ≥ 84.5 kg (relative risks (RR) 2.6, CI 95% 1.2–5.8, p = .017), and body mass index before delivery ≥ 33.3 kg/m² (RR 2.9, CI 95% 1.3–6.4, p = .008). In sPE, the BP decreased between predelivery period and postpartum day 0. From days 1 to 3 postpartum, there was a continuous increase in the daily mean BPs in both groups, with average daily increments (systolic/diastolic) being 5.6/4.6 mmHg and 0.6/1.3 mmHg in the sPE and normotensive women, respectively. Patient’s group and time had a significant effect on BP, p < .001. Overall, daily mean BPs were higher in the sPE than the normotensive group (p < .001). Perceived stress (p = .022), low birth weight (p = .002), 5 min Apgar score ≤ 6 (p < .001) were significantly higher in the sPE group. sFlt-1/PIGF ratio was high in the hypertensive groups: sPE versus normotensive group, p < .001; de novo postpartum hypertension versus normotensives group that remained normotensive, p = .102.

Conclusion: Postpartum BP and antihypertensive requirements are important considerations in managing sPE and normotensive pregnancies. sPE is associated with increased maternal stress and poor perinatal outcomes.

Keywords:

• Caesarean delivery
• perceived stress scale
• perinatal outcomes
• postpartum hypertension
• preeclampsia with severe features

Acknowledgments

We also wish to thank the South African National Health Laboratory Service (in Edendale Hospital) for preserving the serum samples, Roche for providing the sFlt-1 and PIGF reagents, and Ampath Laboratory in Durban, South Africa for measuring the serum concentrations of sFlt-1 and PIGF.

Disclosure statement

No potential conflict of interest was reported by the authors. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the government.

Additional information

Funding

This work was supported by the Office of Global AIDS Coordinator and the U.S. Department of Health and Human Services, National Institutes of Health (NIH OAR and NIH OWAR) under Grant number 5R24TW008863.