Risk factors for re-presentation for postpartum hypertension in patients without a history of hypertension or preeclampsia

BACKGROUND: Re-presentation for evaluation of hypertension following discharge after delivery is common. However, a subset of patients who re-present for evaluation of postpartum hypertension do not have a history of hypertension. Identification of those at risk may help guide postpartum management and prevent re-presentations to the hospital. OBJECTIVE: This study aimed to establish risk factors for representation for hypertension within 30 days of discharge after delivery in patients without a history of hypertension compared with women who did not re-present and to distinguish from risk factors for re-presentation for another reason. STUDY DESIGN: Subjects were identified through data extraction from a single institution between January 2012 and December 2018. We included subjects without an International Classification of Diseases, Ninth Revision or International Classification of Diseases, Tenth Revision code for (1) chronic hypertension or (2) a hypertensive disorder of pregnancy during their delivery encounter who re-presented to the hospital within 30 days. Thus, the re-presentation group was divided into the following 2 groups: those who re-presented for hypertension and those who re-presented for any other reason. Each re-presentation group was compared with the cohort of patients who delivered within the study window and did not re-present using the Student t test or Wilcoxon tests for continuous variables and chi-square or Fisher's exact tests for categorical variables. Multivariable regression was also performed on all potentially important risk factors. RESULTS: Factors that emerged as uniquely significant in the representation group for hypertension were maternal age of >= 40 years and antenatal prescription of low-dose aspirin. Black race and body mass index of >= 30 kg/m(2), although significant in both re-presentation groups, were more strongly predictive of re-presentation for hypertension. These factors remained independently significant when compared with each other in a multivariable analysis. CONCLUSION: There are identifiable risk factors for postpartum re-presentation for hypertension in patients without a history of hypertension. Upon discharge, providers may consider close blood pressure monitoring and follow-up in patients who have any of the following risk factors: age of >= 40 years, black race, body mass index of >= 30 kg/m(2), or those who were prescribed low-dose aspirin in pregnancy.

Automated summary

Factors such as maternal age of >= 40 years, antenatal prescription of low-dose aspirin, black race, and body mass index of >= 30 kg/m(2) were identified as significant risk factors for postpartum re-presentation for hypertension in patients without a history of hypertension. Close blood pressure monitoring and follow-up may be considered for these high-risk patients upon discharge.