Is Preeclampsia With Low Sodium Levels Associated With Increased Need for Antihypertensives? [ID 2683464

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INTRODUCTION: Preeclampsia (PEC) complicates 5–10% of pregnancies. Preeclampsia and low sodium (PALS) has been reported, but risks of low sodium are not well understood. We hypothesize that PALS is associated with increased need for antihypertensives. METHODS: This was an IRB-approved retrospective cohort study of 521 PEC patients with a documented sodium level during delivery or postpartum admission at Mount Sinai Hospital (2013–2021). Primary outcomes were need for emergency antihypertensives during admission and long-acting antihypertensives at discharge. Secondary outcomes were maternal length of stay (LOS), ICU admission, and readmission for PEC. RESULTS: Patients with PALS (sodium <135 mmol/L; n=111) were more likely to be nulliparous (P=.004), have lower body mass index (P=.03), and have a history of PEC (P=.047). In a multivariable logistic regression adjusting for history of PEC, chronic hypertension, aspirin use in pregnancy, multiple gestations, and PEC subtypes, patients with PALS were more likely to require long-acting antihypertensives at discharge (adjusted odds ratio [aOR] 1.79; 95% CI [1.13, 2.83]; P=.01) compared to PEC with normal sodium. Need for emergency antihypertensives, rates of maternal ICU admission and maternal readmission did not differ between groups. However, the distribution of maternal LOS differed between groups (median [interquartile range (IQR)]: 4.0 [3.0, 5.0] for normal sodium, 4.0 [4.0, 6.0] for low sodium; P<.0001). CONCLUSION: Preeclampsia and low sodium is associated with increased need for long-acting antihypertensives at discharge. Preeclampsia and low sodium may represent a more severe PEC presentation, warranting closer attention to sodium levels in the management of PEC patients. Future studies with larger sample sizes are needed to assess the effects of lower sodium levels.