Postpartum Blood Pressure Research Articles

Screening high-risk population of persistent postpartum hypertension in women with preeclampsia using latent class cluster analysis

BackgroundA significant proportion of women with preeclampsia (PE) exhibit persistent postpartum hypertension (PHTN) at 3 months postpartum associated with cardiovascular morbidity. This study aimed to screen patients with PE to identify the high-risk population with persistent PHTN.MethodsThis retrospective cohort study enrolled 1,000 PE patients with complete parturient and postpartum blood pressure (BP) profiles at 3 months postpartum. The enrolled patients exhibited new-onset hypertension after 20 weeks of pregnancy, while those with PE superimposed upon chronic hypertension were excluded. Latent class cluster analysis (LCCA), a method of unsupervised learning in machine learning, was performed to ascertain maternal exposure clusters from eight variables and 35 subordinate risk factors. Logistic regression was applied to calculate odds ratios (OR) indicating the association between clusters and PHTN.ResultsThe 1,000 participants were classified into three exposure clusters (subpopulations with similar characteristics) according to persistent PHTN development: high-risk cluster (31.2%), medium-risk cluster (36.8%), and low-risk cluster (32.0%). Among the 1,000 PE patients, a total of 134 (13.4%) were diagnosed with persistent PHTN, while the percentages of persistent PHTN were24.68%, 10.05%, and 6.25% in the high-, medium-, and low-risk clusters, respectively. Persistent PHTN in the high-risk cluster was nearly five times higher (OR, 4.915; 95% confidence interval (CI), 2.92–8.27) and three times (OR, 2.931; 95% CI, 1.91–4.49) than in the low- and medium-risk clusters, respectively. Persistent PHTN did not differ between the medium- and low-risk clusters. Subjects in the high-risk cluster were older and showed higher BP, poorer prenatal organ function, more adverse pregnancy events, and greater medication requirement than the other two groups.ConclusionPatients with PE can be classified into high-, medium-, and low-risk clusters according to persistent PHTN severity; each cluster has cognizable clinical features. This study’s findings stress the importance of controlling persistent PHTN to prevent future cardiovascular disease.

Association Between Preeclampsia in Prior Pregnancy and Attendance Rates of Postpartum Blood Pressure–Monitoring Appointments After a Subsequent Pregnancy

Preeclampsia complicates approximately 5% of pregnancies and accounts for 10%–15% of maternal deaths. Sixteen percent of patients experience recurrence of preeclampsia in subsequent pregnancies. It is recommended that patients whose pregnancies are complicated by preeclampsia attend a postpartum blood pressure–monitoring appointment at 7–10-days postpartum. Although there are multiple known factors that influence postpartum appointment attendance rates, including race–ethnicity, insurance status, parity, severity of hypertensive disorder, and method of birth, little is known about the effects of preeclampsia in a woman’s prior pregnancy on her blood pressure–appointment attendance rates in a subsequent pregnancy.

Best Practices for Managing Postpartum Hypertension.

Purpose of ReviewPatients remain at risk for persistent and de novo postpartum hypertension related to pregnancy. This review aims to summarize the current definitions, clinical practices, and novel systems innovations and therapies for postpartum hypertension.Recent FindingsRecent changes to the definitions of hypertension outside of pregnancy have not yet impacted definitions or management of hypertensive disorders of pregnancy (HDP), though research examining the implications of these new definitions on risks of developing HDP and the resultant sequelae is ongoing. The administration of diuretics has been shown to reduce postpartum hypertension among women with HDP. Widespread implementation of telemedicine models and remote assessment of ambulatory blood pressures has increased data available on postpartum blood pressure trajectories, which may impact clinical management. Additionally, policy changes such as postpartum Medicaid extension and an increasing emphasis on building bridges to primary care in the postpartum period may improve long-term outcomes for women with postpartum hypertension. Prediction models utilizing machine learning are an area of ongoing research to assist with risk assessment in the postpartum period.SummaryThe clinical management of postpartum hypertension remains focused on blood pressure control and primary care transition for cardiovascular disease risk reduction. In recent years, systemic innovations have improved access through implementation of new care delivery models. However, the implications of changing definitions of hypertension outside of pregnancy, increased data assessing blood pressure trajectories in the postpartum period, and the creation of new risk prediction models utilizing machine learning remain areas of ongoing research.

Mobile Integrated Health for Postpartum Blood Pressure Monitoring: Impact on Hospital Readmissions [A237

INTRODUCTION: Starting in December 2019, Grady Memorial Hospital, a public institution in Atlanta, Georgia, implemented a home visiting mobile integrated health (MIH) program to reduce risk for postpartum complications among women with hypertensive disorders of pregnancy (HDP). We aimed to assess the impact of the MIH intervention on readmission rates. METHODS: Using electronic medical record for all deliveries between March 2018 and June 2021 at Grady Memorial Hospital, we calculated monthly rates of all-cause readmissions within 42 days of delivery discharge. We used a controlled interrupted time series design to compare readmission rates before (March 1, 2018, to November 30, 2019) and after (December 1, 2019, to June 30, 2021) the implementation of the MIH program for deliveries with and without HDP, assuming a level and slope change. Deliveries without HDP were not eligible for the MIH intervention and were used as controls. Emory’s institutional review board approved this study. RESULTS: There were 3,455 deliveries with HDP and 4,479 deliveries without HDP. Overall rates of readmission for deliveries with and without HDP were 3.7% (95% CI, 2.9–4.7%) and 1.8% (95% CI, 1.3–2.4%) in the pre-MIH period and 3.9% (95% CI, 3.0–5.1%) and 1.9% (95% CI, 1.4–2.6%) in the post-MIH period, respectively. We found no evidence of a sudden change in readmission rates (β, 0.029; P=.96) or a linear trend in readmissions (β, –0.069; P=.17) following the implementation of the MIH intervention among deliveries with HDP compared with deliveries without HDP. CONCLUSION: A MIH intervention for women with HDP was not associated with decreased rates of postpartum readmissions in our population.

Implementation of a universal postpartum blood pressure monitoring program: feasibility and outcomes

New-onset postpartum preeclampsia has a higher risk of maternal morbidity and mortality than preeclampsia with antepartum onset, underscoring the need for earlier identification of elevated blood pressure among patients with this condition. Given the decrease in healthcare engagement, which is typical of the postpartum period, new-onset postpartum hypertension often goes unrecognized. Currently, there are no recommendations for universal postpartum blood pressure surveillance in women without hypertensive disorders of pregnancy. With the shift to telemedicine because of the COVID-19 pandemic, our institution's approach was to distribute blood pressure cuffs to women receiving any portion of their prenatal care virtually, thus also providing access to an opportunity for blood pressure measurement during the postpartum period for all women. To explore the feasibility of a patient-driven universal postpartum home blood pressure monitoring program in women without a previous diagnosis of a hypertensive disorder. This was a prospective observational study of all postpartum women who were discharged from our institution from July 2020 through June 2021 and who were not previously identified to have hypertension. A clinical algorithm was developed and followed. All the women received discharge educational materials and were called at a 1-week interval by a nurse to review blood pressure and preeclampsia symptoms. The maternal demographics and delivery outcomes were recorded. Of the 10,092 deliveries during the study period, 5959 (59%) were successfully contacted. 352 were excluded, as they did not deliver at the primary hospital; 1052 (18%) had a previous hypertensive disorder of pregnancy diagnosis; 1522 (26%) did not have a blood pressure cuff; and 1841 (31%) planned to take their blood pressure at a later time. Precautions and blood pressure parameters were given to this last group. Of the remaining 1192, 222 (19%) had an initial elevated blood pressure. Of these, 98 had a second elevated blood pressure on recheck; 17 were referred to the emergency room for evaluation, with 8 being diagnosed with severe preeclampsia; and the remainder were recommended to follow with their obstetrical provider and enrolled in our institution's remote blood pressure management program. Of the 1192 women, 8% potentially had a new diagnosis of a hypertensive disorder of pregnancy, with 0.7% having severe hypertension. Women with elevated blood pressures were more likely to be of non-Hispanic Black race and have a higher early pregnancy body mass index than those without elevated blood pressures. Our study indicates that a patient-driven postpartum blood pressure monitoring program is feasible and may be incorporated using existing resources. In addition, our findings suggest that the incidence of new-onset postpartum hypertensive disorders of pregnancy may be higher than previously assessed in retrospective cohorts. Thus, there may be a role for closer surveillance of all women with patient-driven home blood pressure monitoring, particularly those with risk factors or in the setting of limited resources.

The P4 study: Subsequent pregnancy maternal physiology after hypertensive and normotensive pregnancies.

Hypertensive disorders of pregnancy are associated with subsequent increased risk of cardiometabolic disease. Adverse cardiometabolic measures are noted soon after hypertensive versus normotensive pregnancy (NP); to what degree these persist into a subsequent pregnancy (SP) is unknown. This study aimed to assess women's physiology early in SP after hypertensive pregnancy (HP: preeclampsia or gestational hypertension) or NP and compare SP to 6 months postpartum findings from the index pregnancy. Prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatric) observational cohort. Measurements six months after NP versus HP, and the SP at 11-13 weeks gestation. Blood pressure (BP), blood and urine tests (urine ACR, HOMA-IR, LDL cholesterol), body composition, and contribution of maternal characteristics and inter-pregnancy factors to BP and body fat (FM%) in SP. 49 women (34 NP, 15 HP). In the SP, post-HP women had higher BP (112/70 mmHg HP vs 102/64 mmHg NP; p < .001), with no significant drop from six months postpartum to early SP. On regression analysis, systolic and diastolic BP at 6-months were the major predictors for SP systolic (p < 0.001) and diastolic (p = 0.009) BP respectively in the SP. Longer interpregnancy interval and increased FM% 6-months postpartum were associated with higher SP FM% (p < 0.001). BP and body fat six months postpartum were similar early in the SP for HP group, and postpartum BP and FM% were major predictors of their corresponding SP measurements. Postpartum/inter-pregnancy intervention programs to improve these cardiometabolic risk markers might help improve women's long-term health and require investigation.

Abstract EP50: Implementation Of A Cloud-Connected Remote Blood Pressure Monitoring Program During The Postpartum Period Improves Ascertainment

Introduction: Postpartum hypertension is a leading cause of postpartum hospital readmissions and severe maternal morbidity. Monitoring postpartum blood pressure (BP) through office visits is challenging due to barriers in accessing care, which disproportionately affect people of color. Remote BP monitoring programs are promising but many require cellular data plans or smartphones. The aim of this study is to examine the impact of a cloud-connected remote BP monitoring program in BP ascertainment during the six weeks postpartum in a diverse, safety-net hospital population. Methods: Eligible patients were those delivering between April 2020 through September 2021 at Boston Medical Center and at high-risk of postpartum hypertension, including those with hypertensive disorders of pregnancy, chronic hypertension, or hypertension during hospitalization for delivery. Patients were given a cell-enabled cuff and provided instructions in either English, Spanish, or Haitian Creole to take their BP daily for six weeks. BP measurements are transmitted to a web-based portal via the local cellular network. Data collected through the portal were merged with clinical information from the medical record. Metrics of compliance included frequency, defined as number of daily measurements ascertained, and duration, or day of last measurement, within the six-week period were examined using means and standard deviations (SD). We examined compliance by self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic). We calculated the prevalence of postpartum hypertension, defined as ≥ 2 BP measures with systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg. Severe hypertension was defined as SBP ≥160 and/or DPB ≥110. Results: Among the 3,525 deliveries during the study period, 1,008 (28.6%) were eligible for the program. Of the eligible participants, 40.5% identified as Black (n=409), 36.3% as Hispanic (n=366), and 14.4% as White (n=145). Participation was high; only 15 patients (1.5%) did not take any BP measures. Among the 993 participants, the average number of daily BP measures was 17.1 (SD: 10.4), which was similar across racial/ethnic groups (Black: 17.3, Hispanic: 16.5, White: 17.1). Furthermore, the mean duration of participation was 31.7 days (SD: 12.2), which was also similar by race/ethnicity. In this high-risk cohort, the prevalence of postpartum hypertension was 64.3% (n=638), with 9.6% (n=61) meeting severe criteria. Conclusion: In conclusion, implementation of a cloud-connected BP monitoring program among a diverse, safety-net population was successful at ascertaining multiple BP measures in the postpartum period. Furthermore, similar patterns of use across racial and ethnic groups suggest that this program could reduce disparities with respect to postpartum BP ascertainment.

Postpartum blood pressure self-management following hypertensive pregnancy: protocol of the Physician Optimised Post-partum Hypertension Treatment (POP-HT) trial

IntroductionNew-onset hypertension affects approximately 10% of pregnancies and is associated with a significant increase in risk of cardiovascular disease in later life, with blood pressure measured 6 weeks postpartum predictive...

Biological and sociocultural determinants of increased blood pressure among women with a history of gestational diabetes mellitus in rural China: a retrospective cohort study

ObjectivesGestational diabetes mellitus (GDM) increases the risk of hypertension and cardiovascular events among mothers later in life. This risk has not been well recognised by healthcare professionals in rural China....

Race and BMI affect postpartum blood pressure trajectory

Understanding postpartum blood pressure trajectory may guide interventions to reduce morbidity and mortality among women with hypertensive disorder of pregnancy (HDP). Our objective was to evaluate postpartum blood pressure (BP) trajectory and the effect of race and obesity on these patterns.

Postpartum Blood Pressure Findings and Readmission

To understand how blood pressure (BP) values and management of hypertension relate to readmission for preeclampsia with severe features, particularly in regard to the American Heart Association (AHA) guidelines.

The impact of hypertensive status and race on the postpartum blood pressure trajectory

Limited data exists regarding the trajectory of blood pressure (BP) in the postpartum period (PP) for normotensive and hypertensive pregnancies. Lack of data is responsible for conflicting guidelines regarding the ideal time for PP follow up. Therefore, we developed a maternal BP trajectory using accurately obtained BP measurements in PP.

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

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.

Characteristics of Patients Who Attend the 7- to 10-Day Postpartum Visit for Blood Pressure Evaluation.

This study aimed to assess maternal characteristics that predict attendance of postpartum blood pressure evaluation in patients with hypertensive disorders of pregnancy (HDP). A retrospective case-control study of patients with HDP delivering at a single academic institution (2014-2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of the 7- to 10-day postpartum blood pressure evaluation. Of the 1,041 patients included in the analysis, 603 (57.9%) attended the 7- to 10-day postpartum blood pressure check. Maternal sociodemographic, clinical, and obstetric factors differed significantly between patients who attended the postpartum blood pressure visit and those who did not. In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild-range blood pressures on day of discharge, and initiation of antihypertensive medication were associated with attendance of the 7- to 10-day postpartum visit. In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (adjusted odds ratio [aOR]: 1.58; 95% confidence interval: [CI]: 1.14-2.17), severe HDP (aOR: 1.94, 95% CI: 1.44-2.61), and cesarean birth (aOR: 1.92, 95% CI: 1.43-2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR: 0.68, 95% CI: 0.47-0.97), and public insurance (aOR: 0.65, 95% CI: 0.45-0.93) compared with private insurance. Clinical factors such as nulliparity, severe HDP, and cesarean birth were associated with higher rates of postpartum blood pressure evaluation attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance. · A total of 57.9% of patients with HDP attended in person postpartum blood pressure check.. · Nulliparity, severe features of HDP, and cesarean birth were associated with higher rates of attendance.. · Non-Hispanic black race and ethnicity and public insurance were associated with lower attendance..

Postpartum Outcomes With Systematic Treatment and Management of Postpartum Hypertension.

To test the ability of a hospital-wide, bundled quality-improvement initiative to improve postpartum maternal blood pressure control and adherence to postpartum follow-up among patients with hypertensive disorders of pregnancy. This quality-improvement initiative consisted of a bundle of clinical interventions including health care professional and patient education, a dedicated nurse educator, and protocols for postpartum hypertensive disorders of pregnancy care in the inpatient, outpatient and readmission setting. We implemented this initiative in patients with hypertensive disorders of pregnancy starting in January 2019 at the University of Chicago. The study period was divided into four periods, which correspond to preintervention, distinct bundle roll outs, and postintervention. Our primary outcome was postpartum hypertension visit adherence. Secondary outcomes included blood pressure values and antihypertensive medication use in the immediate postpartum and outpatient postpartum time periods. We then stratified our outcomes by race to assess whether the effect size differed. A total of 926 patients who delivered between September 2018 and November 2019 were included. Postpartum hypertension visit adherence improved from preintervention period compared with the full implementation period (33.5% vs 59.4%, P<.001). Blood pressure in the first 24 hours postpartum decreased from preintervention compared with full implementation (preintervention median [interquartile range] systolic blood pressure 149 mm Hg [138, 159] vs 137 [131, 146] in postimplementation; P<.001). After implementation, fewer patients experienced a blood pressure of 140/90 mm Hg or higher at the first postpartum blood pressure check, when compared with preintervention (39.1% vs 18.5%, P=.004). The effect size did not differ by race. A bundled quality-improvement initiative for patients with hypertensive disorders of pregnancy was associated with improved postpartum visit adherence and blood pressure control in the postpartum period.

Demographic and Clinical Predictors of Postpartum Blood Pressure Screening Attendance.

Background: Hypertensive disorders of pregnancy (HDP) cause substantial preventable maternal morbidity and mortality. Postpartum hypertension that worsens after women are discharged is particularly dangerous, as it can go undiagnosed and cause complications. The American College of Obstetricians and Gynecologists recommends women with HDP undergo blood pressure (BP) screening 7-10 days after delivery to detect postpartum hypertension. This study aimed to describe predictors of postpartum BP screening attendance among a high-risk safety-net population in Atlanta, Georgia. Materials and Methods: We conducted a population-based cohort study of pregnant women who delivered at a large public hospital in Atlanta between July 1, 2016, and June 30, 2018. We manually abstracted demographic and clinical data from electronic medical records and used multivariable log binomial regression to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) for associations with BP screening attendance. Results: Of 1260 women diagnosed with HDP, 13.7% attended a BP screening visit within 10 days of delivery. Women with preeclampsia with severe features were more likely to attend a BP visit than women with gestational hypertension (aRR 2.10, 95% CI 1.35-3.27). Rates of BP screening attendance were lower for women with inadequate (aRR 0.42, 95% CI 0.26-0.67) and intermediate (aRR 0.40, 95% CI 0.21-0.74) prenatal care utilization relative to women with adequate utilization. Conclusions: Among a high-risk safety-net population with HDP, most women did not attend a BP screening visit within 10 days of delivery. Addressing this gap requires further research and creative solutions to address barriers at the individual, provider, and system levels.

O-011. Pre-pregnancy stress leads to impaired placental development, post-partum high blood pressure and vascular dysfunction

O-011. Pre-pregnancy stress leads to impaired placental development, post-partum high blood pressure and vascular dysfunction

Abstract MP65: Increased Sedentary Time Is Associated With Greater Postpartum Blood Pressure In Women With A History Of Preeclampsia

Introduction: Women with a history of preeclampsia (hxPE) are at a four-fold increased risk for chronic hypertension and have elevated aortic stiffness compared withhealthy pregnancy (HP). Higher sedentary time (ST) is related to higher odds of hypertension in clinic among young women regardless of the amount of moderate-to-vigorous physical activity (MVPA). As pregnancy and postpartum are uniquely vulnerable times of increased sedentary behavior, the objectives of this study were to determine whether ST is associated with higher blood pressure (BP) and aortic stiffness in women with hxPE compared with HP 1-3 years postpartum, and if change in ST from late pregnancy to postpartum is related to change in BP or aortic stiffness. Methods: Women with hxPE (N=33) and HP (N=46) completed the Pregnancy Physical Activity Questionnaire (PPAQ) 18±6 months postpartum. BP was assessed in triplicate in clinic and by 24-hour ambulatory blood pressure monitoring and aortic stiffness by carotid-femoral pulse wave velocity (CFPWV). In a subset of women (N=20), clinic BP, CFPWV and the PPAQ were previously evaluated in the third trimester. Results: Women with hxPE reported more leisure-time ST compared with HP (18 [7-19] vs 7 [5-7] MET-hr/wk, P&lt;0.001), whereas MVPA did not differ (77 [39-106] vs 56 [35-88] MET-hr/wk, P=0.13). 24-hour ambulatory BP was higher in women with hxPE (120 [114-126] vs 114 [109-120] mmHg, P=0.049; 78 [72-82] vs 74 [70-77] mmHg, P=0.056), but CFPWV did not differ independently of BP (6.1 vs 5.5 m/s, P=0.33). Postpartum ST, but not MVPA, was associated with higher 24-hr systolic (ρ=0.24, P=0.04) and diastolic BP (ρ=0.27, P=0.02) and higher CFPWV (ρ=0.31, P=0.008) independent of body mass index. Increases in ST from late pregnancy to postpartum (0 [-3-2] ΔMET-hr/wk, P=0.22) was related to increased BP (systolic ρ=0.42, P=0.06; diastolic ρ=0.44, P=0.050) and increases in CFPWV (ρ=0.54, P=0.02) despite a reported increase in MVPA (21.5 [-0.5-63] ΔMET-hr/wk, P=0.04). Conclusions: Greater ST is related to higher BP and aortic stiffness 1-3 years postpartum, and women with hxPE report greater leisure-time ST compared with HP controls. Reduction in ST may represent an achievable interventional strategy to improve cardiovascular health in women with hxPE.

Implementation of a text-based postpartum blood pressure monitoring program at 3 different academic sites

Up to 30% of patients with hypertensive disorders of pregnancy continue to have elevated blood pressures after delivery, often necessitating medication titration or hospital evaluation in the weeks following hospital discharge. A previous randomized controlled trial demonstrated that remote blood pressure monitoring programs led to an increase in the number of blood pressure measurements obtained and increased compliance with clinical guidelines regarding the monitoring of patients for persistent or worsening postpartum hypertension. The aims of this study were to measure the program participant response rates during the first 10 days after hospital discharge, to assess the replicability and scalability of the program, and to evaluate patient satisfaction at 3 distinct sites. We conducted a prospective observational cohort study across 3 US academic medical centers during which postpartum participants with hypertensive disorders of pregnancy were enrolled in a previously validated, remote, text message-based blood pressure monitoring program known as Heart Safe Motherhood. English-speaking patients with access to a text message-enabled cell phone and with a diagnosis of hypertensive disorders of pregnancy were candidates for enrollment in the study. Each study site planned to enroll approximately 66 participants in this pilot implementation phase. All the enrolled participants received a validated blood pressure cuff, education on proper use of the device, and were sent text messages as a reminder to check their blood pressures twice daily for 10 days after discharge. They were asked to reply via text message with their blood pressure readings. All blood pressure readings were reviewed via a web-based platform by a physician. Physicians communicated with patients whose blood pressure levels exceeded 160 mm Hg systolic or 100 mm Hg diastolic to determine the next management steps. Enrollees were texted a survey at the end of the 10 days and the responses were recorded. The proportion of eligible parturients who were enrolled, the number of measured blood pressure values, and the postprogram survey results were measured. We assessed the number of patients who reported elevated blood pressures, required antihypertensive medication, and were readmitted for blood pressure control during the program duration. A total of 199 participants were enrolled in the program: 66 at site A, 67 at site B, and 66 at site C. In the 10 days after hospital discharge, 192 (97%) participants submitted at least 1 blood pressure measurement via text message. More enrolled patients submitted a blood pressure measurement on postpartum days 7 to 10 (171, 86%) than on days 1 to 4 (134, 67%). A total of 126 (63%) participants submitted blood pressures during both time frames. Elevated blood pressures were recorded for 70 (35%) participants, 32 (16%) of whom were started on oral antihypertensives after discussing their blood pressure measurements with an on-call provider. A total of 10 participants (5%) required hypertension-related readmission after delivery. The end-of-program survey was completed by 98 (49%) of the participants. Of those who completed the survey, 93% agreed that the program helped them to monitor their blood pressure (89% at site A; 88% at site B, and 100% at site C), and 93% would recommend it to friends or family members (94% at site A, 96% at site, and 88% at site C). Postpartum participants are willing and capable of using the Heart Safe Motherhood program for remote blood pressure monitoring and reported high satisfaction with the program across multiple sites. Our study demonstrated that this remote blood pressure monitoring program can be implemented successfully and demonstrated replicable efficacy at diverse sites.

Association between breastfeeding and preeclampsia in parous women: a case \u2013control study

BackgroundPreeclampsia is a global health problem and it is the main cause of maternal and perinatal morbidity and mortality. Breastfeeding has been reported to be associated with lower postpartum blood pressure in women with gestational hypertension. However, there is no published data on the role that breastfeeding might play in preventing preeclampsia. The aim of the current study was to investigate if breastfeeding was associated with preeclampsia in parous women.MethodA case-control study was conducted in Saad Abualila Maternity Hospital in Khartoum, Sudan, from May to December 2019. The cases (n = 116) were parous women with preeclampsia. Two consecutive healthy pregnant women served as controls for each case (n = 232). The sociodemographic, medical, and obstetric histories were gathered using a questionnaire. Breastfeeding practices and duration were assessed.ResultsA total of 98 (84.5%) women with preeclampsia and 216 (93.1%) women in the control group had breastfed their previous children. The unadjusted odds ratio (OR) of preeclampsia (no breastfeeding vs breastfeeding) was 3.55, 95% confidence interval (CI) 1.64,7.70 and p value = 0.001 based on these numbers. After adjusting for age, parity, education level, occupation, history of preeclampsia, history of miscarriage, body mass index groups the adjusted OR was 3.19, 95% CI 1.49, 6.82 (p value = 0.006).ConclusionBreastfeeding might reduce the risk for preeclampsia. Further larger studies are required.