Clinical Factors Associated With Lower Postpartum Follow-up Among Women With Severe Preeclampsia [75

Abstract

INTRODUCTION: Preeclampsia is associated with long-term adverse outcomes, and, therefore, postpartum follow-up is critical. Despite the importance, there continue to be poor postpartum follow-up rates. We aimed to determine factors that are associated with lower postpartum follow-up among women with severe preeclampsia. METHODS: This was a planned secondary analysis of a retrospective cohort of women with severe preeclampsia who delivered between July 2011 and February 2013. Charts were reviewed for data abstraction and to confirm diagnosis. Women were included if they were diagnosed with severe preeclampsia before active labor and were at greater than 34 weeks of gestation. χ2 test compared categorical variables; Student t-test compared parametric data. RESULTS: A total of 202 women were included. The 6-week postpartum follow-up rate was 52.0%. Of women with severe preeclampsia, 77.2% were African American; however, these women were less likely to follow-up than were Caucasian women (46.8 compared with 73.9%, P=.02). Women with more prenatal visits were more likely to follow-up (8.7±3.2 compared with 6.9±3.7, P<.001), as were older women (27.8±3.8 compared with 24.8±5.9, P=.002). Additionally, there was a higher rate of follow-up among those who had undergone cesarean delivery (66.7%) compared with those who had undergone vaginal delivery (44.4%, P=.003). The rate of follow-up was not associated with body mass index, parity, gestational age at diagnosis of severe preeclampsia, neonatal intensive care unit admission, or being discharged home on a blood pressure medicine. CONCLUSION: In this study, we found an association with lower rates of postpartum follow-up among women who are African American, younger, had fewer prenatal visits, and underwent vaginal delivery. Identifying these characteristics will help target at-risk populations to implement strategies for improving follow-up.