Persistent Hypertension Up to One Year Postpartum among Women with Hypertensive Disorders in Pregnancy in a Low-Resource Setting: A Prospective Cohort Study.

Salisu M Ishaku,Joyce L Browne,Oyeneyin Lawal,Hanifah D Abubakar,Onyebuchi K Azubuike,Odusolu O Patience,Tunau Karima,Charlotte E Warren,Abdulkarim Musa,Owa O Olorunfemi,Dattijo Lamaran,Aminu M Baffah,Agbo P Innocent,Diederick E Grobbee,Arie Franx,Tukur Jamilu,Kayode A Gbenga

doi:10.5334/gh.854

Abstract

Background:Hypertensive disorders in pregnancy (HDPs) are associated with lifelong cardiovascular disease risk. Persistent postpartum hypertension in HDPs could suggest progression to chronic hypertension. This phenomenon has not been well examined in low- and middle-income countries (LIMCs), and most previous follow-ups typically last for maximally six weeks postpartum. We assessed the prevalence of persistent hypertension up to one year in women with HDPs in a low resource setting and determined associated risk factors.Methodology:A prospective cohort study of women conducted at eight tertiary health care facilities in seven states of Nigeria. Four hundred and ten women with any HDP were enrolled within 24 hours of delivery and followed up at intervals until one year postpartum. Descriptive statistics were performed to express the participants’ characteristics. Univariable and multivariable logistic regressions were conducted to identify associated risk factors.Results:Of the 410 women enrolled, 278 were followed up to one year after delivery (follow-up rate 68%). Among women diagnosed with gestational hypertension and pre-eclampsia/eclampsia, 22.3% (95% CI; 8.3–36.3) and 62.1% (95% CI; 52.5–71.9), respectively, had persistent hypertension at six months and this remained similar at one year 22.3% (95% CI; 5.6–54.4) and 61.2% (95% CI; 40.6–77.8). Maternal age and body mass index were significant risk factors for persistent hypertension at one year [aORs = 1.07/year (95% CI; 1.02–1.13) and 1.06/kg/m2 (95% CI; 1.01–1.10)], respectively.Conclusion:This study showed a substantial prevalence of persistent hypertension beyond puerperium. Health systems in LMICs need to be organized to anticipate and maintain postpartum monitoring until blood pressure is normalized, or women referred or discharged to family physicians as appropriate. In particular, attention should be given to women who are obese, and or of higher maternal age.

Highlights

Hypertensive disorders in pregnancy (HDPs) complicate 5–10% of pregnancies and annually responsible for, at least, 70,000 and 500,000 maternal and neonatal deaths, respectively [1, 2]
Bearing in mind delivery of the placenta is considered the cure for HDPs, the traditional expectation is that hypertension resolves by the end of the puerperium, a period generally defined as six to eight weeks after delivery [4]
While these studies looked at either pre-eclampsia or gestational hypertension, the patterns and magnitude of prevalence of persistent hypertension across HDP sub-types and time from delivery appear common in sub-Saharan African women and others

Summary

Introduction

Hypertensive disorders in pregnancy (HDPs) complicate 5–10% of pregnancies and annually responsible for, at least, 70,000 and 500,000 maternal and neonatal deaths, respectively [1, 2]. Emerging evidence suggests that hypertension may persist for a variable period beyond puerperium and up to years after delivery – especially following severe forms of HDPs such as pre-eclampsia and eclampsia [5, 6]. This is due to a combination of two factors. We assessed the prevalence of persistent hypertension up to one year in women with HDPs in a low resource setting and determined associated risk factors. Attention should be given to women who are obese, and or of higher maternal age

Methods

Results

Discussion

Conclusion