Postpartum Hypertension Research Articles

Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk.

Obesity is a well-established risk factor for both adverse pregnancy outcomes (APOs) and cardiovascular disease (CVD). However, it is not known whether APOs are mediators or markers of the obesity-CVD relationship. This study examined the association between body mass index, APOs, and postpartum CVD risk factors. The sample included adults from the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be) Heart Health Study who were enrolled in their first trimester (6 weeks-13 weeks 6 days gestation) from 8 United States sites. Participants had a follow-up visit at 3.7 years postpartum. APOs, which included hypertensive disorders of pregnancy, preterm birth, small-for-gestational-age birth, and gestational diabetes, were centrally adjudicated. Mediation analyses estimated the association between early pregnancy body mass index and postpartum CVD risk factors (hypertension, hyperlipidemia, and diabetes) and the proportion mediated by each APO adjusted for demographics and baseline health behaviors, psychosocial stressors, and CVD risk factor levels. Among 4216 participants enrolled, mean±SD maternal age was 27±6 years. Early pregnancy prevalence of overweight was 25%, and obesity was 22%. Hypertensive disorders of pregnancy occurred in 15%, preterm birth in 8%, small-for-gestational-age birth in 11%, and gestational diabetes in 4%. Early pregnancy obesity, compared with normal body mass index, was associated with significantly higher incidence of postpartum hypertension (adjusted odds ratio, 1.14 [95% CI, 1.10-1.18]), hyperlipidemia (1.11 [95% CI, 1.08-1.14]), and diabetes (1.03 [95% CI, 1.01-1.04]) even after adjustment for baseline CVD risk factor levels. APOs were associated with higher incidence of postpartum hypertension (1.97 [95% CI, 1.61-2.40]) and hyperlipidemia (1.31 [95% CI, 1.03-1.67]). Hypertensive disorders of pregnancy mediated a small proportion of the association between obesity and incident hypertension (13% [11%-15%]) and did not mediate associations with incident hyperlipidemia or diabetes. There was no significant mediation by preterm birth or small-for-gestational-age birth. There was heterogeneity across APO subtypes in their association with postpartum CVD risk factors and mediation of the association between early pregnancy obesity and postpartum CVD risk factors. However, only a small or nonsignificant proportion of the association between obesity and CVD risk factors was mediated by any of the APOs, suggesting APOs are a marker of prepregnancy CVD risk and not a predominant cause of postpartum CVD risk.

EVALUATION AND MANAGEMENT OF POSTPARTUM HYPERTENSION IN A TERTIARY CARE HOSPITAL

Objective: The objective is to study the causative factors of postpartum hypertension (PPHTN), time taken for control of blood pressure (BP) in postpartum period and to study the anti-hypertensive drugs used in control of PPHTN. Methods: The study was conducted for 1½ years. During the study, 190 women in postpartum period with high BP were enrolled in the study. A detailed record of history and general physical examination and local examination was done as per pro forma after written informed consent. Results: Out of 190 subjects, 168 had a history of hypertension (HTN) in the antenatal period, and the rest 22 went on to develop HTN in the postpartum period. Gestational HTN and preeclampsia were the most frequent types of hypertensive disorders seen among subjects. In 42.1% of patients, PPHTN developed after 48 h and in 23.7% of cases developed within 48 h. BP normalized post-delivery in 22.6% of subjects. The majority (74.1%) of subjects took tablet labetalol post-delivery. 62.1% of patients took anti-hypertensive for more than 7 days and were discharged on treatment with advice to follow-up. 15.3% took treatment for <7 days. No treatment was required by 22.6% of subjects. Conclusion: Our data identified a high prevalence of PPHTN. We found a significant correlation between the levels of severity of antepartum BP with the level of severity of postpartum BP. Monitoring of HTN is important in the postpartum period for all patients as the majority develop hypertension after 48 h.

A randomized controlled trial comparing the efficacy of nifedipine and enalapril in the postpartum period

Postpartum hypertension is a common medical complication of pregnancy and is associated with increased healthcare use, including unplanned interactions with the medical system and readmission, which can add significant stress to both a newly postpartum patient and the medical care delivery system. We currently do not know what the best antihypertensive treatment for postpartum hypertension is and tend to use antihypertensives commonly used during pregnancy. However, the mechanism of action of angiotensin-converting enzyme inhibitors may be well suited for the pathophysiology of hypertension in the postpartum period and may help to provide better control of hypertension and, in turn, decrease healthcare use. This study aimed to determine if enalapril is superior to nifedipine in preventing prolonged hospitalizations, unplanned medical visits, and/or readmission among women with postpartum hypertension. We performed an open-label, randomized controlled trial(ClinicalTrials.gov registered: NCT04236258)in which patients≥18 years with chronic hypertension, gestational hypertension, or preeclampsia were recruited to receive either 10 mg enalapril daily or 30 mg extended-release nifedipine daily as an initial antihypertensive agent in the period from delivery to 6 weeks postpartum. Recruitment occurred at a tertiary academic hospital from January 2020 to February 2021. Exclusion criteria included being on an antihypertensive when pregnancy started or requiring≥2 daily antihypertensives during pregnancy. The antihypertensive regimen was managed by the participants' obstetrical provider after the initial randomization. The primary outcome was a composite of prolonged hospitalization, unplanned clinic visits, triage visits, and/or readmission. A total of 40 patients in each arm were needed to detect a decrease in the primary outcome rate from 70% to 40% (α=0.05; power 0.80). Analyses were performed based on the intention-to-treat principal, and each arm was oversampled because of the risk for participant dropout. A total of 47 patients were randomized to each arm. Aside from the mode of delivery and twin gestation, the maternal demographics were similar between the 2 groups. The primary outcome occurred in 31 of 47 patients (66%) randomized to the nifedipine group and in 30 of 47 (64%) randomized to the enalapril group (P=.83). There was no significant difference in the primary outcome after controlling for mode of delivery and twin gestation. More patients in the enalapril arm had a second antihypertensive added during their primary hospitalization (16 vs 6) and more patients in the nifedipine arm were still on their antihypertensive at 2 weeks postpartum (42 vs 36). There were no adverse events in either group. Enalapril was not superior to nifedipine when used as an initial antihypertensive in the immediate postpartum period in terms of decreasing healthcare use.

STUDY OF DETERMINANTS OF PERSISTENT POSTPARTUM HYPERTENSION AT 6 W IN WOMEN WITH PRE-ECLAMPSIA

Objective: Pre-eclampsia is a pregnancy disorder with hypertension and proteinuria. Abnormal placental development and maternal/fetal genetic factors contribute to its pathogenesis. Women with pre-eclampsia are at higher risk of chronic hypertension, emphasizing the importance of postnatal monitoring and preventive measures.
 Methods: The study was conducted at the Department of Obstetrics and Gynaecology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, from November 2017 to March 2019. Ethical clearance and informed consent were obtained. A total of 150 consecutive women with pre-eclampsia were included. Detailed history, clinical examination, and investigations were conducted. Women were followed until discharge and at 6 w postpartum. Determinants of persistent postpartum hypertension were compared between two groups, and statistical analysis was performed.
 Results: This study aimed to investigate the clinical and biochemical determinants of persistent postpartum hypertension at 6 w in women with pre-eclampsia. A total of 125 out of 150 eligible women with pre-eclampsia were followed up at 6 w postpartum. Socio-demographic, clinical, obstetrical, and treatment-related parameters were analyzed, and logistic regression. A p-value of <0.05 was considered significant.
 Conclusion: In conclusion, parity and previous history of hypertension consistently emerge as risk factors for persistent postpartum hypertension in women with pre-eclampsia, variations in the literature call for further research to reconcile discrepancies and enhance understanding.

Abstract P424: Postpartum Blood Pressure Trajectories After Hypertensive Disorders Of Pregnancy

Background: Following a hypertensive disorder during pregnancy, blood pressure (BP) generally decreases rapidly in the first three weeks postpartum followed by a period of stabilization. Little is known about patterns of deviation from this trend. Methods: Patients with hypertension during pregnancy (chronic, gestational, or during delivery hospitalization) were enrolled in a remote BP monitoring program and provided with a cell-enabled cuff to take daily BP measurements during their first six weeks postpartum. Measurements were transmitted to a portal and integrated with their electronic medical record. Patients delivering between January 2021 and December 2022 with ≥2 BP measures at an urban safety net hospital were included (n=1,571). Quadratic group-based trajectory models were used to identify latent patterns of postpartum systolic BP (SBP) and diastolic BP (DBP) over time, a method that can be used to capture clinically distinct sub-groups of patients. Patients were grouped into one of four trajectories based on posterior probabilities. Demographic and reproductive characteristics of each trajectory group were examined. Results: Based on 1,571 patients with an average of 15 postpartum BP measurements per patient, the group trajectory model identified 4 trajectories of SBP and DBP (labeled as starting BP value-rate of BP decline): (1) low-steep (SBP 123, DBP 78), (2) moderate-steep (SBP 134, DBP 87), (3) high-gradual (SBP 143, DBP 93), and (4) high-flat (SBP 146, DBP 95). The percent of patients falling into each SBP trajectory group were (1)22.6 (n=346), (2)38.0 (n=611), (3)28.6 (n=451), (4)10.8 (n=163), and for DBP were (1)18.2 (n=288), (2)35.4 (n=557), (3)31.9 (n=508), and (4)14.4 (n=218). Key demographic and pregnancy characteristics varied across SBP and DBP trajectory groups. The high-flat groups were most likely to be older (≥36 years) and non-Hispanic Black. The high-flat SBP and DBP groups had the highest percentage of preterm births (26.4%, 43 out of 163; 20.6%, 45 out of 218, respectively). Conclusion: In this on-going observational study, we characterized 4 distinct group trajectories of SBP and DBP in the 6-weeks postpartum. These data may aid in the identification of patients at risk of persistent postpartum hypertension.

The joint effect of gestational diabetes mellitus and hypertension contribute to higher risk of diabetes mellitus after delivery: a nationwide population-based study

BackgroundGestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) are known risk factors for postpartum diabetes mellitus (DM) and hypertension, respectively. This study aimed to examine the association between the co-occurrence of GDM and PIH and the subsequent development of diabetes mellitus (DM), hypertension, and metabolic syndrome.MethodsA cohort study was conducted using data from the Taiwan National Health Insurance Research Database (TNHIRD). The study population included 2,297,613 pregnant women with no history of certain medical conditions who gave birth between 2004 and 2015. The women were classified into four cohorts based on their medical history: GDM cohort, PIH cohort, both GDM and PIH cohort, and normal cohort (without GDM and PIH).ResultsThe GDM cohort had a higher risk of developing DM, hypertension, and metabolic syndrome than the normal cohort, with hazard ratios of 7.07, 1.54, and 2.51, respectively. The PIH cohort also had an increased risk for these conditions compared with the normal cohort, with hazard ratios of 3.41, 7.26, and 2.68, respectively. The cohort with both GDM and PIH had the highest risk of developing postpartum DM, hypertension, and metabolic syndrome, with hazard ratios of 21.47, 8.02, and 5.04, respectively, compared with the normal cohort.ConclusionThe cohort of patients with both GDM and PIH had the highest impact on developing postpartum DM compared with either condition alone cohort. Furthermore, the co-occurrence of both conditions increases the risk, with a higher likelihood of developing postpartum DM than hypertension or metabolic syndrome.

Analysis of postpartum hypertension in women with preeclampsia

Postpartum hypertension including persistent and recurrent hypertension could significantly affect maternal morbidity in preeclampsia. Data on the postpartum management of women with preeclampsia is limited. The objective of this study was to investigate the details of women experiencing persistent postpartum hypertension (PerPPH) or developing recurrent postpartum hypertension (RecPPH) after birth and whether the treatment with anti-hypertensive drugs could shorten the hospital stay. We also compared the clinical parameters in women who developed RecPPH and who did not. Data on 188 preeclamptic women, including the severity or time of onset, duration of hospital admission postpartum, and blood pressure during the admission were collected and analyzed. Overall, 30% of preeclamptic women developed RecPPH on day 1, 13% on day 3, and 12% on day 5 after birth. Women with severe preeclampsia or early onset preeclampsia are more likely to develop RecPPH, compared to women with mild or late onset preeclampsia. The overall time in days before discharge was not different between women with normal blood pressure and women with abnormal blood pressure 1 h after birth, regardless of the severity or gestation of onset. However, women with severe or early onset preeclampsia stayed longer in the hospital, compared to women with mild or late onset preeclampsia. In addition, women with severe or early onset preeclampsia or early delivery increased risk of developing RecPPH. In conclusion, we demonstrate that RecPPH became apparent on day 1 after delivery, and hence close monitoring of blood pressure even if initially seemingly normal after birth is important.

Is magnesium sulfate therapy warranted in all cases of late postpartum severe hypertension? A suggested approach to a clinical conundrum

Magnesium sulfate reduces the risk for eclamptic seizures antepartum, intrapartum, and in the immediate postpartum period, however, there are no studies that have evaluated the benefits and risks of magnesium sulfate among women with late postpartum severe hypertension only. Juxtaposed on this clinical uncertainty is the increased incidence of severe hypertension owing to a rise in pregnancies complicated by advanced maternal age, obesity, chronic hypertension, diabetes, and recent protocols for intensive monitoring of blood pressure in the postpartum period. These factors have led to a significant increase in postpartum presentations for the evaluation and management of severe hypertension, in some cases leading to postpartum readmissions for administration of antihypertensive therapy and magnesium sulfate without data demonstrating clear clinical benefit. Postpartum readmissions can have several negative consequences, including interfering with early bonding with a newborn, breastfeeding, and use of scarce healthcare resources. In addition, magnesium sulfate is associated with risks for serious cardiorespiratory depression and bothersome side effects and can delay determining the optimal antihypertensive regimen, which is typically the most pressing clinical need during postpartum presentations of late-postpartum severe hypertension. Eclampsia that occurs more than 48 hours after delivery is rare (constitutes 16% of all cases of eclampsia) and is most commonly preceded by headaches or other cerebral symptoms. In this commentary, we propose an approach to evaluating and managing patients with late postpartum severe hypertension aimed at identifying those women at highest risk for end-organ injury. We recommend that the short- and long-term focus for all patients with severe hypertension should be the optimal management of blood pressures with a goal of close outpatient monitoring when logistically feasible and clinically appropriate. We suggest reserving magnesium sulfate therapy for the subset of patients with neurologic symptoms who may be at highest risk for an eclamptic seizure.

Feasibility of Virtual Blood Pressure Monitoring Titrated to ACC/AHA Thresholds Among Outpatients With Postpartum Hypertension

Feasibility of Virtual Blood Pressure Monitoring Titrated to ACC/AHA Thresholds Among Outpatients With Postpartum Hypertension

Pre-eclampsia and Cardiovascular Disease: From Pregnancy to Postpartum.

Hypertensive disorders of pregnancy (HDP) complicate approximately 10% of pregnancies. In addition to multiorgan manifestations related to endothelial dysfunction, HDP confers an increased risk of cardiovascular disease during delivery hospitalisation, such as heart failure, pulmonary oedema, acute MI and cerebrovascular events. However, the cardiovascular legacy of HDP extends beyond birth since these women are significantly more likely to develop cardiovascular risk factors in the immediate postnatal period and major cardiovascular disease in the long term. The main mediator of cardiovascular disease in women with a history of HDP is chronic hypertension, followed by obesity, hypercholesterolaemia and diabetes. Therefore, optimising blood pressure levels from the immediate postpartum period until the first months postnatally could have beneficial effects on the development of hypertension and improve long-term cardiovascular health. Peripartum screening based on maternal demographic, and clinical and echocardiographic data could help clinicians identify women with HDP at highest risk of developing postpartum hypertension who would benefit from targeted primary cardiovascular prevention.

BASELINE CARDIAC BIOMARKER ANALYSIS FROM THE BASEL POSTPARTUM HYPERTENSION REGISTRY

Objective: Postpartum hypertension (PPHT) is defined by elevated blood pressure measurements after birth of more than 140 mmHg systolic and more than 90 mmHg diastolic, that persist or develop directly after pregnancy and is associated with adverse cardiovascular and renal outcome. Aim of the current analysis was the evaluation of different prognostic cardiac and stress related biomarkers like cardiac troponin T (cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) in the setting of PPHT. Design and method: Enrollment for the prospective observational Basel Postpartum Hypertension Registry began in June 2020 at the University Hospital Basel. Women with preexisting hypertension, hypertensive disorders of pregnancy (HDP), and de novo postpartum hypertension were enrolled and followed up in structured management program. Clinical history and lab values were collected out of the electronic health records. Additional blood samples were stored for further evaluation. The present analysis contains biomarker analysis of a subset of 58 out of 288 patients using blood samples taken within one week of giving birth. Serum samples were analyzed for detectable levels of cTnT, NT-proBNP and GDF-15 at the department for Laboratory Medicine at University Hospital Basel using electrochemiluminescence immunoassay Elecsys on the Cobas e 801 platform (Roche Diagnostics, Rotkreuz, Switzerland). Results: Mean age of the patients from whom we measured biomarkers at baseline was 34±4.7. Mean troponin was 8.5 ng/l ±2.2 with normal cuttoffs for this age group being 14ng/l and sex specific cutoffs at 9ng/l. NT-proBNP was 229.86ng/l ±80.4, with 125ng/l being the normal cut off in an acute disease setting. Mean GDF-15 was 1895.8ng/l ±323.5 with correlating normal values in healthy populations in the same age range being 564 ± 223 ng/l. Conclusions: This first biomarker analysis shows a trend of elevated NT-proBNP and GDF-15 which are associated with cardiovascular disease or stress. Cardiac troponin T was not elevated in most of the patients, but in a subset of 13 patients. Further analysis and long term outcome correlations remains to be established and may be part of the follow-up analyses of the Basel PPHT cohort.

Rural-urban residence and sequelae of hypertensive disorders of pregnancy in the first year postpartum, 2007 - 2019.

To estimate the association between rural residence and sequelae of hypertensive disorders of pregnancy (HDP) in the first year postpartum. We used the Maine Health Data Organization's All Payer Claims Data to identify women with HDP who delivered during 2007-2019 and did not have chronic hypertension or pre-pregnancy cardiac conditions (n=8882). We used Cox proportional hazards modeling to estimate rural-urban hazard ratios (HR) and 95% confidence intervals (CI), adjusting for HDP subtype, age, insurance, nulliparity, and co-morbidities. Results were stratified by HDP subtype and timing of acute care visits. Risk of at least one emergency room or inpatient visit related to hypertension or cardiovascular conditions in the first year postpartum and receipt of outpatient antihypertensive medications from 4days to 1year postpartum, separately. Overall, risk of at least one acute care visit in the first year postpartum was not different between rural vs urban women (4.2% vs 4.2%; adjusted HR 0.98; 95% CI 0.79,1.21), and outpatient receipt of antihypertensive medication was not different (12.9% vs 12.8%; adjusted HR 0.99; 95% CI 0.87, 1.12). However, stratified analyses suggested some differences (e.g. preeclampsia with severe features: acute care visit adjusted HR 1.54; 95% CI 0.95, 2.49). Rural and urban women do not differ in the risks of these common HDP sequelae, though rural women may have increased risk by HDP subtype or timing of acute care visit. Future research should investigate postpartum interventions for reducing HDP sequelae in rural and urban women.

A case of Conn syndrome presenting as persistent post-partum hypertension

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Does a Lower Target of Postpartum Blood Pressure Reduce Readmission Rates in Patients With Hypertensive Disorders of Pregnancy? [ID: 1377089

INTRODUCTION: The classification of normal blood pressure in the general population, as determined by multiple organizations including the American Heart Association, American College of Cardiology, and National Institutes of Health, has been evolving. In the pregnant and postpartum population, the threshold of normal blood pressure is higher. Postpartum hypertension has been estimated to affect 20% of women and plays a large role in maternal readmissions. In those with hypertensive disorders of pregnancy, the target postpartum blood pressure should be reevaluated in light of the lower thresholds of the general population. METHODS: This study included pregnant patients with singleton fetuses and a diagnosis of chronic hypertension, gestational hypertension, preeclampsia, and eclampsia who delivered at Luminis Health Anne Arundel Medical Center from January 2019 to 2022. The primary outcome was hospital readmission for a hypertensive diagnosis or related sequelae within the first 30 days of delivery. This study was approved by IRB ID 1735193-1. RESULTS: Out of 1,433 patients with hypertensive disorders of pregnancy, 55 patients (3.8%) were readmitted because of hypertensive disorders or related complications. Patients with a maximum blood pressure after delivery of greater than or equal to 150/100 mm Hg were significantly more likely to be readmitted (odds ratio 1.99 [1.06, 3.75]). The maximum blood pressure on the day of discharge and oral antihypertensive initiation were not significantly associated with readmission. CONCLUSION: For postpartum patients with mild hypertension, a target blood pressure of below 150/100 mm Hg should be considered. Next steps include examining the effect of magnesium sulfate, furosemide, and discharge medication compliance in this population.

Postpartum Emergency Department Visits and Risk Factors for Readmission [ID: 1363150

INTRODUCTION: Postpartum emergency department (ED) visits complicate 12% of births. We aimed to characterize trends in ED visits and risk factors for readmission. METHODS: This was a retrospective cohort study on postpartum ED visits within 42 days of delivery at a tertiary care center over 1 year. Readmitted patients were compared to those who remained outpatient as appropriate. IRB #14-001098. RESULTS: Of 3,084 deliveries, 138 (4.5%) patients presented to the ED for total 157 encounters. 17 (12.3%) patients presented more than once. 55 (35%) ED visits resulted in readmission, with 4 patients readmitted twice. Public insurance rates in the cohort were significantly higher than baseline (16.7% versus 8.5%, P=.001). Postpartum hypertension (HTN) was the most common reason for ED visits (40%) and had four times higher likelihood of being readmitted (adjusted odds ratio [aOR] 4.076, 95% CI 2.04–8.15, P<.001). Black women were six times more likely to be readmitted compared to other groups (aOR 6.53, 95% CI 1.26–33.88, P=.026). Coexistent psychiatric disease had lower likelihood of readmission (aOR 0.43, 95% CI 0.19–0.95, P=.037). Having more than one ED visit led to fivefold higher odds of readmission (aOR 5.05, 95% CI 1.66–15.32, P=.004). Median days from delivery to ED visit were 8 (interquartile range [IQR]: 5, 15). CONCLUSION: Seventy-three percent of presentations to the ED were within 2 weeks of delivery, and postpartum HTN was the leading cause. Black patients were more likely to be readmitted. Further studies are needed to evaluate whether earlier postpartum visits for high-risk groups may reduce ED visits and readmissions.

Postpartum Titration of Antihypertensives in Patients With Hypertensive Disorders of Pregnancy [ID: 1380430

INTRODUCTION: Postpartum hypertension is observed in up to 20% of patients within 6 weeks of delivery. While blood pressure evaluation is an integral component of prenatal care, effective blood pressure follow-up postpartum is uncertain. The objective of this study was to evaluate the use of antihypertensive medications and subsequent dosage adjustments in the postpartum period. METHODS: This was a retrospective qualitative observational study of patients with hypertensive disorders of pregnancy who delivered at a single quaternary care safety net hospital from July to December 2021. Patients with at least one of the following diagnoses: chronic hypertension (cHTN), gestational hypertension (gHTN), and/or severe preeclampsia (SPE), were included. Data collected included initiation and/or titration of antihypertensives during delivery admission, postpartum visit attendance, outpatient antihypertensive dose adjustments, and emergency department visits. RESULTS: From July to December 2021, 1,232 pregnancies were complicated by hypertensive disorders: gHTN only, 577 (46.8%); both gHTN and cHTN, 34 (2.8%); both gHTN and SPE, 499 (40.5%); and all three, 122 (9.9%). Of these, 256 (20.8%) required initiation and/or titration of antihypertensives during delivery admission with over 90% of these complicated by SPE. Of the 197 (77.0%) attending at least one follow-up, medication was stopped in 26 (13%), increased in 9 (5%), decreased in 22 (11%), and continued unchanged in 140 (71%). The majority of medication adjustment occurred in the first 2 weeks postpartum. CONCLUSION: Postpartum hypertensive therapy management occurs predominantly within 2 weeks postpartum, with nearly one-fourth decreasing and only 5% requiring increased medication.

Development of maternal syndrome during pregnancy enhances the severity of post-partum salt-sensitive hypertension and renal damage in the Dahl SS rat

Preeclampsia (PE) is a pregnancy-specific disorder that is characterized by hypertension and proteinuria (maternal syndrome). Our group has demonstrated that Dahl salt-sensitive rats maintained on a low salt casein-based diet (SSC) develop maternal syndrome, while Dahl SS rats maintained on a low salt wheat gluten-based diet (SSWG) are protected. Population-based data demonstrated woman that experience a preeclamptic event are at an increased risk for developing hypertension and kidney disease after the pregnancy relative to woman who have a normotensive pregnancy. Since the SSC are susceptible to developing maternal syndrome, we tested the hypothesis that following a single pregnancy SSC rats would exhibit greater salt sensitive hypertension and renal damage relative to SSWG rats in response to a postpartum high salt (HS) challenge. To test this hypothesis SSC and SSWG rats were exposed to a single pregnancy, allowed to deliver naturally and then pups were weaned at 3 weeks. Following a postpartum urinalysis, dams recovered for one week before a two week HS diet challenge. Blood pressure and proteinuria were tracked throughout the study and immune cell infiltration was assessed at the end of the HS challenge. Despite exhibiting comparable baseline MAP measured via telemetry (135±6 vs 126±4mmHg, p>0.05) and urinary protein excretion levels (42.3±5 vs 26.7.1±7 mg/day, p>0.05, n=4-5/group), the SSC rats exhibit significantly elevated postpartum MAP (147±7 vs 131±2 mmHg, p<0.05) and proteinuria (230±40 vs 75±11 mg/day, p<0.05) relative to the SSWG mated rats. Additionally, when these animals were challenged with a postpartum HS diet, the SSC mated rats exhibited an exacerbated response in both MAP (ΔMAP: 22±5 vs 6±3, p<0.05) and proteinuria (300±25 vs 122±20 mg/day, p<0.05) that is accompanied with a significant reduction in creatinine clearance (CC: 0.31±0.08 vs 0.63±0.02 mL/min/g, p<0.05) relative to the SSWG mated rats. These findings are specific to pregnancy in the SSC rats since diet-matched virgin controls only exhibited a slight ΔMAP (SSC Virgin: 10±4mmHg, SSWG Virgin: 9±1mmHg) in response to a HS diet and comparable CC to the SSWG mated rats (SSC Virgin: 0.48±0.07, SSWG Virgin: 0.63±0.06 mL/min/g, p>0.05). These renal damage phenotypes observed in the mated SSC are associated with a two-fold increase in infiltrating immune cells including monocytes/macrophages, T and B cells relative to all other groups. These data suggest the renal demand of an adverse pregnancy that occurs in maternal syndrome is exacerbated with a secondary insult such as a high salt diet. Future studies will investigate the mechanisms behind these pregnancy-induced renal damage phenotypes and how an adverse pregnancy can lead to worsened health outcomes for both mother and offspring. HL157549, HL161231 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

MomHEART: Utilization of a Web-Based Postpartum Hypertension Platform [ID: 1371438

INTRODUCTION: Maternal complications of hypertensive disorders of pregnancy (HDP) extend to the postpartum period. Remote blood pressure (BP) monitoring and online educational platforms may improve a patient's knowledge, accessibility, and adherence to BP monitoring allowing for earlier identification of complications. We sought to compare differences in postpartum hypertension platform utilization based on severity of HDP. METHODS: We performed a single-center, prospective implementation study of women enrolled in a web-based postpartum hypertension platform called MomHEART. Through MomHEART, women received educational information about BP monitoring, text message reminders or calls from virtual nurses to log their BP daily for 14 days. Primary outcome was utilization defined as logging a BP, viewing educational information, and/or interacting with a virtual nurse. Descriptive statistics were used to analyze our data. A Fisher exact test was used to compare program utilization based on hypertensive severity. RESULTS: Sixty-four patients were enrolled from April to July 2022. The mean gestational age at delivery was 37.1 weeks. Participants were more likely to be Black, single, have insurance, and delivery vaginally. Thirty-two participants (50%) had HDP with severe features, and 32 (50%) had HDP without severe features. Forty-nine (76.6%) participants interacted with MomHEART. We found no difference in platform utilization by severity of hypertensive diagnosis. CONCLUSION: Utilization of MomHEART did not vary based on hypertension severity. Overall, utilization was high, indicating participants found MomHEART valuable. This is a small pilot study on the utilization of the MomHEART program. Additional analysis will be performed to assess the efficacy of identifying maternal hypertensive complications in the postpartum period.

Postpartum Home Blood Pressure Monitoring Program: Improving Care for Hypertension During Postpartum after a Hospital Birth.

Hypertensive disorders of pregnancy complicate about 10% of pregnancies and are a leading cause of maternal morbidity and mortality. The purpose of this quality improvement project was to evaluate a program to provide a home blood pressure monitor to all postpartum patients who had a hypertensive diagnosis and elevated blood pressure. The program includes a blood pressure monitor, instructions for its use, education about hypertension, and a guidance grid with standardized blood pressure parameters reviewed prior to discharge from the hospital. Patients are taught about potential adverse outcomes during postpartum. Patients are instructed to follow-up with their care provider based on the parameters. A retrospective medical record review was used to evaluate clinical outcomes. Medical records of 185 patients indicated that 20% ( n = 36) who received the home BP monitor reported one or more mild-to-severe range blood pressure(s) during postpartum. Twenty-eight percent ( n = 52) had outpatient medication adjustments, including decreasing, increasing, starting, and discontinuing medications. Nine percent ( n = 17) of patients returned to the obstetric triage for evaluation. There was patient overlap between those experiencing elevated blood pressures, medication adjustments, and those who returned to hospital for evaluation. Ongoing monitoring may improve identification and management of postpartum hypertension and potentially prevent progression to hypertensive-related adverse events.

Postpartum Readmission for Hypertension: The Patient Experience [ID: 1377602

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research has led to the creation of clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this project is to understand the perspective of patients readmitted for postpartum hypertension. METHODS: Institutional review board committee approval was obtained for the study. This was a qualitative study with data generated through semistructured interviews. Patients readmitted with postpartum HDP at an urban academic medical center were approached and consented for a single interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n=9). Two coders coded all interviews using NVivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus. Researchers identified themes through grounded theory and were reflexive in their thematic generation. RESULTS: Five themes were generated through the grounded theory analysis: Every pregnancy is different, symptoms of preeclampsia are easily dismissed or often not taken seriously, miscommunication regarding medical changes can hinder patient care, readmission logistics are not baby-friendly, and patient well-being improved when conversations acknowledged the struggles of readmission. CONCLUSION: A qualitative research process revealed patient-identified gaps in care that may have led to readmission for HDP. The specific recommendations that emerge from these themes include: addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.