Introduction: Postpartum hypertension is a leading cause of severe maternal morbidity and mortality. Approximately half of those with hypertensive disorders of pregnancy (chronic hypertension, preeclampsia, gestational hypertension) remain hypertensive after delivery and are at an increased risk of being readmitted to the hospital postpartum. Postpartum remote blood pressure monitoring (RBPM) may be an effective tool to reduce hospital readmission rates. Hypothesis: Postpartum RBPM reduces both short-term (30 day) and long-term (1 year) hospital readmission rates. Methods: We conducted an electronic medical record (EMR) based cohort study. We included patients who delivered between 2021-2023 with hypertensive disorders of pregnancy and were enrolled in an RBPM program (RBPM group). We used a comparison group of patients who delivered at the same hospital between 2016-2018, prior to the RBPM program (pre-implementation group), who would have been eligible to participate had the program been in place. Sociodemographic and pregnancy data were abstracted from the patient EMR. For analyses, we included deliveries ≥20 gestational weeks among patients aged ≥18 years. We evaluated risk of short- and long-term hospital readmission for 1) all-causes and 2) hypertension-related reasons. Log-binomial regression estimated risk ratios (RR) and 95% confidence intervals (CI) for the effect of postpartum RBPM on hospital readmissions. Results: Among 4,948 patients (pre-implementation: n=2,807, RBPM: n=2,141), baseline characteristics were similar (non-Hispanic Black: 46% vs 46.3%, mean maternal age: 31 (SD 6.1) vs 30 (SD 6.1) years, respectively). The RBPM group had lower short-term readmission rates for all-causes (4.9% vs 5.7%) and hypertension-related reasons (4% vs 4.3%). The RBPM group also had lower long-term readmission rates for all-causes (6.9% vs 7.5%). In models adjusted for type of hypertensive disorder in pregnancy and age, the RBPM group had a lower risk of short-term readmission compared to the pre-implementation group (all-causes: RR 0.69 (95% CI 0.55, 0.89); hypertension-related: RR 0.70 (95% CI 0.53, 0.93)). The RBPM group was also less likely to be readmitted long-term compared to the pre-implementation group (all-causes: RR 0.76 (95% CI 0.62, 0.94); hypertension-related: RR 0.77 (95% CI 0.59, 0.98)). Conclusions: In a diverse, safety-net population, postpartum RBPM reduced hospital readmissions within 30 days and 1 year following hypertensive disorders of pregnancy.

Introduction: Limited multi-language access in healthcare is a public health concern as language barriers can contribute to lower quality care, miscommunication, and adverse health effects. Language barriers also reduce engagement with digital health technologies, such as remote blood pressure monitoring (RBPM), often developed for English speakers. Hypothesis: There is lower engagement in postpartum RBPM and higher occurrence of postpartum readmission among non-English speakers than English speakers. Methods: In 2020, a large safety-net hospital implemented a postpartum RBPM program for patients with hypertensive disorders of pregnancy, including chronic or gestational hypertension, preeclampsia, and hypertension during delivery hospitalization. Program materials and messaging are available in several languages including Spanish, Haitian Creole, and English. Patients are instructed to take their BP daily up to 6 weeks postpartum using a cell-enabled cuff that automatically uploads readings to a provider-facing portal. Using health records, we abstracted data including race, ethnicity, nativity, and language as well as healthcare utilization through 12 months postpartum. Program engagement was examined by preferred language during the six-week postpartum period using two measures: frequency, defined as the number of days with ≥1 BP reading, and duration, defined as the last day with a recorded reading. We also examined the proportion of patients readmitted to the hospital by preferred language within 12 months postpartum. Results: Between January 2021 and June 2023, 2,200 patients were enrolled in the RBPM program of which 94% (n=2,069) provided ≥2 BP measures. Frequency (days with BP measures) and duration (last day with a BP measure) of program engagement were higher among Spanish (mean: 15.7; 31.7) and Haitian Creole (mean: 17.4; 34.1) speakers compared to English speakers (mean: 13.6; 29.9). Approximately 7% (n=153) of patients were readmitted within 12 months postpartum. Readmission rates were highest among English (8.3%) and Haitian Creole (6.8%) speakers and lowest among Spanish speakers (3.8%), though differences between language groups may be partially explained by variations in race, ethnicity, and nativity. Conclusions: These findings suggest that when digital health programs are designed with intentional language inclusivity, non-English speakers can engage as effectively as English speakers which may translate to reductions in postpartum readmission rates.

Introduction: Postpartum hypertension is a leading cause of severe maternal morbidity, yet most patients receive a single blood pressure (BP) check before the 6-week visit. Remote BP monitoring (RBPM) programs address this gap by enabling continuous postpartum surveillance. At a large safety-net hospital, patients with hypertensive disorders of pregnancy (HDP) were provided RBPM cuffs as part of routine postpartum care, allowing for daily BP tracking. This cohort study estimated time to hypertension resolution during the first 6 weeks (42 days) postpartum among RBPM patients, overall and by HDP subtype. Hypothesis: Time to hypertension resolution is expected to be longest among patients with preeclampsia, often the most severe HDP subtype, compared to those with gestational or de novo postpartum hypertension. Methods: This cohort study included patients who delivered between January 2021 and June 2023 and recorded ≥2 daily BP measurements using a RBPM cuff after an HDP diagnosis. HDP subtypes included gestational hypertension, preeclampsia, and de novo postpartum hypertension detected during the delivery hospitalization; patients with chronic hypertension were excluded. Hypertension resolution was defined as ≥2 consecutive days of normal BP (systolic BP <130 and diastolic BP <80 mmHg) without antihypertensive medication use. A lenient definition (≥1 vs ≥2 days of normal BP) was also examined. Time to resolution through 42 days postpartum was estimated using Kaplan-Meier methods, overall and by HDP subtype; patients not achieving resolution were censored after ≥7 consecutive days without BP measures or at day 42. Results: Among 1,773 patients, 31.5% met the definition of hypertension resolution over the 6-week postpartum period. Those who achieved resolution were less likely to be English speakers (47.7% vs 58.3%), born in the United States (28.5% vs 38.0%), and have a preterm birth (9.5% vs 18.5%) compared with those censored. Average time to resolution was 15.0 days (SD 10.1). By HDP subtype, average time to resolution was 13.2 days (SD 8.7) for gestational, 13.6 days (SD 8.7) for de novo postpartum, and 19.0 days (SD 12.0) for preeclampsia. Under the lenient definition, 62.6% met hypertension resolution at 10.0 days on average (SD 10.5). Conclusions: On average, patients required >2 weeks to reach hypertension resolution. Less stringent definitions of resolution may misclassify patients as normotensive, emphasizing the need for longer-term BP monitoring.

Background/Objectives: Previous literature has described that non-white pregnant patients are at increased risk of severe morbidity from obstetric hemorrhage (OBH). Here, we investigate whether such disparities are secondary to delay in the administration of postpartum oxytocin for non-white patients compared to white patients. Methods: This is a retrospective cohort study of all deliveries from 2018 to 2019, comparing (1) Hispanic white or non-white race (HW/NWR) pregnant people and (2) non-Hispanic white (NHW) pregnant people. Our primary outcome was the time from delivery to the first dose of postpartum oxytocin, and our secondary outcome was the frequency of other hemorrhage interventions. Results: Out of 3832 patients with self-identified race and ethnicity recorded in their patient record, 644 patients identified as NHW, and 3188 patients identified as HW/NWR. We found no difference in time to first dose of postpartum oxytocin (p = 0.51), and there was also no difference in the frequency of other hemorrhage-related interventions. Conclusions: Our study found no delay in the administration of postpartum oxytocin for non-white patients.

Background: Multimorbidity affects approximately 1 in 3 adults and is associated with adverse health outcomes. However, there is a paucity of information describing patterns of multimorbidity among the birthing population. The objective of this study was to describe the clustering of pre-pregnancy chronic conditions in the birthing population by age, race and ethnicity, insurance status, and parity using latent class analysis (LCA). Study design: We conducted a retrospective cohort study of deliveries using medical record data between 2015 and 2019. Multimorbidity was defined as having at least two chronic conditions before the start of the index pregnancy, using adapted versions of obstetric comorbidity indices. The final LCA model was selected based on clinical interpretability and statistical fit. We also compared the distribution of sociodemographic factors across classes. Results: Of 6,455 deliveries, 1,870 (29%) deliveries were to patients with multimorbidity. LCA resulted in a 3-class model: Class 1 (45% of individuals with multimorbidity) was characterized by mood/anxiety and substance use disorders; class 2 (39%) was defined by body mass index >= 30 kg/m(2) and chronic hypertension; and class 3 (16%) was characterized by reproductive conditions and infertility. Individuals who were <25 years or non-Hispanic White were more frequently in class 1; individuals who were >= 35 years or non-Hispanic Black were disproportionately in class 2. Nulliparas and individuals with private insurance were more frequently in class 3. Conclusion: Multimorbidity is prevalent in pregnancy and distinct chronic condition clusters vary across sociodemographic sub-groups, demonstrating the need for integrative approaches to periconceptional care for birthing individuals with multimorbidity.

Aims and ObjectivesOur goal is to describe the association between total quantitative blood loss (QBL) and risk of obstetric haemorrhage-related morbidity (OBH-M) to assess the utility of the current definition of obstetric haemorrhage (OBH). MethodsThis was a retrospective cohort study completed of all patients who had a live delivery at the only urban safety-net hospital over a 2-year period from 2018 to 2019. We categorized deliveries into 10 equally sized deciles based on QBL and compared the proportion with OBH-M in each. Among the two deciles with the highest proportions of OBH-M, we stratified deliveries into seven groups of ascending intervals of 250cc QBL. Finally, we compared the positive predictive value (PPV) of the standard definition of OBH (QBL >= 1000cc) to a definition extrapolated from our stratified analysis. The primary outcome was proportion of deliveries within each QBL decile affected by OBH-M. The secondary outcome was PPV. ResultsWe found a significant increase in OBH-M from decile 9 (895-1201cc QBL) to decile 10 (1205-8325cc QBL) (p < 0.001). In our stratified analysis, we found QBL of 1500cc to be an inflection point for an increased proportion of OBH-M. Our secondary analysis showed an increased PPV for OBH-M using QBL of 1500cc (20.5%) compared with that of QBL 1000cc (9.8%). ConclusionsOur findings suggest that a higher QBL threshold than the currently accepted definition of OBH is more predictive of OBH-M.

Purpose Postpartum hypertension (PPHTN) poses increased risks, including of stroke. Timely assessment and management by clinicians is imperative but challenging. Team-based care involving pharmacists has shown promise in improving blood pressure control, yet its application in PPHTN management remains unexplored. The objective of this study was to determine the impact and feasibility of an interprofessional model for PPHTN management.Summary This initiative implemented a novel interprofessional model at a safety-net hospital to address previous workflow limitations. Ambulatory care pharmacists collaborated with an obstetric nurse (OBRN) and a maternal fetal medicine specialist to manage high-risk patients with PPHTN utilizing electronic consults (e-consults). Data collection and symptom assessment were completed by an OBRN via telemedicine appointments. Pharmacists employed a collaborative practice agreement based on a preestablished algorithm to initiate medications. Data on patient demographics, consult volume, prescriptions, and pharmacist comfort were collected during the first quarter of full integration. Pharmacists completed 55 e-consults and generated 54 prescriptions. The average time spent per chart review was 12.5 minutes, and the average time to completion of e-consults was 54 minutes. Forty-five unique patients received care, who were primarily non-English-speaking and non-Hispanic Black patients. Pharmacists reported moderate to high comfort levels in managing PPHTN based on the algorithm and provided feedback leading to workflow adjustments.Conclusion Integration of pharmacists into PPHTN care enables prompt medication initiation and titration. This innovative model, involving remote blood pressure monitoring, telemedicine visits with an OBRN, and e-consults completed by pharmacists, ensures delivery of timely and equitable care and improved access across a diverse population.

Introduction: People of color and non-English speakers are underrepresented in research and disproportionately affected by health-related social needs (HRSNs). Research engagement can be particularly challenging after pregnancy as postpartum care attendance is low. We describe our experience with remote recruitment modalities in a such a population. Methods: The study population included all patients affected by hypertension during a pregnancy who delivered at a large safety-net hospital 1/2022-6/2023. These patients also engaged in 6 weeks of remote blood pressure monitoring postpartum. Patients were contacted between 6 weeks and 12 months post-delivery to complete an online survey regarding HRSNs and provide consent to link survey data to clinical data. The recruitment protocol included initial outreach via the electronic medical record (EMR) patient portal, if available, or else a hard copy letter via mail, followed by a series of text messages then phone calls. All communication was conducted in the patient’s primary language (English, Spanish, or Haitian Creole). Results: We recruited 148 (9.4%) of 1571 patients contacted. Respondents were 51% Black, 39% Latina, 26% White. Table illustrates the comparable rate of recruitment across languages, dominance of EMR as mode of engagement and an illustration of the high rate of complex HRSN among our participants. The most effective recruitment method was EMR communication (57% of total recruitment) followed by text messages (28%). Our Haitian Creole-speaking respondents had the highest rates of HRSN - possibly representing the Haitian migrant crisis affecting Boston in this time period - as well as the highest rate of engaging via EMR messaging. Other domains of HRSN were high among all language groups including trouble affording medication (11-23%) and heating/electric access (21-34%). Conclusions: A diverse postpartum population with a high prevalence of HRSNs is hard to engage in research. Despite presumed digital barriers, EMR and secure text were effective and secure methods of online survey recruitment. Future studies seeking to understand the intersection of health outcomes and HRSNs should consider adding recruitment with EMR to common texting strategies.

Objective The aim of this study was to assess whether inclusion of intrapartum risk factors improves our obstetric hemorrhage risk stratification tool in predicting obstetric hemorrhage, transfusion, and related severe morbidity.Study Design This is a retrospective cohort study using all live deliveries at a single institution over a 2-year period ( n = 5,332). Obstetric hemorrhage risk factors, hemorrhage burden, and severe maternal morbidity index outcomes were assessed through chart abstraction. Hemorrhage risk was assessed at (1) "time of admission " through chart abstraction and (2) "predelivery " by calculation after inclusion of all abstracted intrapartum risk factors. Admission high risk was compared with predelivery high risk for sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio in predicting obstetric hemorrhage, obstetric hemorrhage requiring transfusion, and obstetric hemorrhage-related severe morbidity. Significance levels were calculated using descriptive statistical methods including chi-squared tests and McNemar's tests.Results The sensitivities of the risk assessment tool using admission risk classification for high-risk patients is 25% for obstetric hemorrhage, 37% for obstetric hemorrhage requiring transfusion, and 22% for obstetric hemorrhage-related severe morbidity. After intrapartum factor inclusion, the sensitivities increase to 55% for obstetric hemorrhage, 59% for obstetric hemorrhage requiring transfusion, and 47% for obstetric hemorrhage-related severe morbidity. This "predelivery " risk assessment is significantly more sensitive across all three end points ( p < 0.001 for all three outcomes). While the positive likelihood ratios for obstetric hemorrhage are equal on admission and predelivery (2.10 on admission and predelivery), they increase after intrapartum factor inclusion for obstetric hemorrhage requiring transfusion and obstetric hemorrhage-related severe morbidity (on admission, 2.74 and 1.6, respectively, and predelivery: 4.57 and 3.58, respectively).Conclusion Inclusion of intrapartum risk factors increases the accuracy of this obstetric hemorrhage risk stratification tool in predicting patients requiring hemorrhage management with transfusion and obstetric hemorrhage-related severe morbidity.

Despite recommendations for ongoing care after pregnancy, many individuals do not see a primary care clinician within the first postpartum year, missing a critical window to engage reproductive-age individuals in primary care. We administered an anonymous, cross-sectional, trilingual survey at a large urban safety-net hospital to assess postpartum individuals’ preferences, health concerns, and anticipated barriers to primary care during the year after pregnancy. While 90

ObjectiveSARS-CoV-2 infection during pregnancy has been linked with an increased risk of hypertensive disorders of pregnancy (HDP). The aim of this study was to examine how both trimester and severity of SARS-CoV-2 infection impact HDP.MethodsWe conducted a cohort study of SARS-CoV-2-infected individuals during pregnancy (n = 205) and examined the association between trimester and severity of infection with incidence of HDP using modified Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI). We stratified the analysis of trimester by severity to understand the role of timing of infection among those with similar symptomatology and also examined timing of infection as a continuous variable.ResultsCompared to a reference cohort from 2018, SARS-CoV-2 infection did not largely increase the risk of HDP (RR: 1.17; CI:0.90, 1.51), but a non-statistically significant higher risk of preeclampsia was observed (RR: 1.33; CI:0.89, 1.98), in our small sample. Among the SARS-CoV-2 cohort, severity was linked with risk of HDP, with infections requiring hospitalization increasing the risk of HDP compared to asymptomatic/mild infections. Trimester of infection was not associated with risk of HDP, but a slight decline in the risk of HDP was observed with later gestational week of infection. Among patients with asymptomatic or mild symptoms, SARS-CoV-2 in the first trimester conferred a higher risk of HDP compared to the third trimester (RR: 1.70; CI:0.77, 3.77), although estimates were imprecise.ConclusionSARS-CoV-2 infection in early pregnancy may increase the risk of HDP compared to infection later in pregnancy.

Background Postpartum hypertension is a risk factor for severe maternal morbidity; however, barriers exist for diagnosis and treatment. Remote blood pressure (BP) monitoring programs are an effective tool for monitoring BP and may mitigate maternal health disparities. We aimed to describe and evaluate engagement in a remote BP monitoring program on BP ascertainment during the first 6‐weeks postpartum among a diverse patient population. Methods and Results A postpartum remote BP monitoring program, using cell‐enabled technology and delivered in multiple languages, was implemented at a large safety‐net hospital. Eligible patients are those with hypertensive disorders before or during pregnancy. We describe characteristics of patients enrolled from January 2021 to May 2022 and examine program engagement by patient characteristics. Linear regression models were used to calculate mean differences and 95% CIs between characteristics and engagement metrics. We describe the prevalence of patients with BP ≥140/or >90 mm Hg. Among 1033 patients, BP measures were taken an average of 15.2 days during the 6‐weeks, with the last measurement around 1 month (mean: 30.9 days), and little variability across race or ethnicity. Younger maternal age (≤25 years) was associated with less frequent measures (mean difference, −4.3 days [95% CI: −6.1 to −2.4]), and grandmultiparity (≥4 births) was associated with shorter engagement (mean difference, −3.5 days [95% CI, −6.1 to −1.0]). Prevalence of patients with BP ≥140/or >90 mm Hg was 62.3%, with differences by race or ethnicity (Black: 72.9%; Hispanic: 52.4%; White: 56.0%). Conclusions A cell‐enabled postpartum remote BP monitoring program was successful in uniformly monitoring BP and capturing hypertension among a diverse, safety‐net hospital population.

To elucidate the association between GBS infection and maternal risk for obstetric hemorrhage (OBH) and OBH-related morbidities (OBH-M). This was a retrospective cohort study of all deliveries with a documented GBS status at a single large academic medical center from 2018 to 2019. GBS status was determined by either urine culture or rectovaginal culture collected during the antepartum period. The primary outcomes were quantitative blood loss (QBL), OBH, and a composite of OBH-M. Secondary outcomes were individual components of the OBH-M composite and frequency of hemorrhage-related interventions utilized intrapartum and postpartum. A stratified analysis was conducted examining only patients who were diagnosed intrapartum with an intrapartum intraamniotic infection (III). Of 4679 pregnant individuals who delivered a live infant between January 1, 2018 and January 1,2019 with a documented GBS status, 1,487 were identified as GBS positive (+) and 3192 were identified as GBS negative (−). The GBS + group did not have significantly higher QBL (p = 0.29) or rate of OBH (p = 0.35). There were no significant differences by GBS status in OBH morbidity (p = 0.79) or its individual components or frequency of individual pharmacologic or non-pharmacologic OBHrelated interventions. There were also no significant differences by GBS status among patients with an III. GBS infection at the time of delivery was not associated with increased risk for OBH or OBH-M. Further research is needed to further explore the relationship between peripartum infections and OBH risk. GBS infection in neonates has long been feared due to life-threatening outcomes for the neonate, yet few studies have studied the impact of GBS infection on mothers Vornhagen (Trends Microbiol 25(11):919–931, 2017); Chun-Chih (Pediatr Neonatol 59(3):231–237, 2018); Hirsch (Nat Commun 9(1):263, 2018). Our study fills this gap by exploring the effects of GBS infection on maternal OBH while using quantitative blood loss (QBL) methods, which have been shown to be more accurate than the visually estimated methods used in previous studies.

Background: Primary care after pregnancy is recommended, especially for individuals with recent adverse pregnancy outcomes (APOs, such as preeclampsia or gestational diabetes), who are at increased risk for future heart disease. Health-related social needs (HRSNs) are recognized barriers to care, yet their pregnancy-related prevalence and associations with care are unknown. We sought to (1) describe the pregnancy-related prevalence of HRSNs, and (2) assess associations between pregnancy-related HRSNs and subsequent linkage to primary care. Methods: We analyzed electronic health record data for individuals with prenatal care and delivery (2018-2021) at our urban safety-net hospital. HRSNs were assessed via a routine screener, and we summarized individual responses during pregnancy through 6 weeks post partum as: any positive, all negative, or never screened. Postpartum linkage to primary care was defined as a completed primary care visit after 6 weeks through 1 year post partum. We analyzed the prevalence of HRSNs and their associations with linkage to primary care, using adjusted log-linked binomial regression models. In stratified models we assessed for effect modification by APO history and other variables. Results: Of 4941 individuals in our sample, 53% identified as Black non-Hispanic and 21% as Hispanic, 68% were publicly insured, and 93% completed ≥1 HRSN screening. Nearly 1 in 4 screened positive for any HRSN, most often food insecurity (14%) or housing instability (12%), and 53% linked to primary care. Compared with those who screened negative for all HRSNs (n=3491), linkage to primary care was similar among those who screened positive for any HRSNs (n=1079; adjusted risk ratio, aRR 1.04, 95% confidence interval, CI: 0.98-1.10) and lower among those never screened (n=371; aRR 0.77, 95% CI: 0.68-0.86). We found no evidence of effect modification by APO history, race/ethnicity, insurance, language, or Covid-19 pandemic exposure. Conclusions: In this diverse postpartum sample, we identified a 24% prevalence of pregnancy-related HRSNs and 53% subsequent linkage to primary care. Linkage to primary care was not associated with HRSN screening result (positive versus negative) but was significantly negatively associated with being missed by HRSN screening. Further research is needed to better understand HRSN screening practices and who is missed by screening, and to identify modifiable barriers to postpartum primary care especially after APOs.

INTRODUCTION:Ongoing care after pregnancy is recommended. Health-related social needs are recognized barriers to care, yet their pregnancy-related prevalence and associations with care are unknown. Researchers sought to assess (1) the prevalence of health-related social needs during pregnancy-based care, and (2) their associations with ongoing care after pregnancy. METHODS:Electronic health record data were analyzed for individuals with prenatal care and delivery (2018-2021) at an urban safety-net hospital, with routine screening for health-related social needs multiple times during pregnancy through 6 weeks postpartum. Health-related social needs were summarized as screened negative, screened positive, or not screened. Linkage to ongoing care was defined as a completed non-urgent visit separate from pregnancy-based care, >6 weeks through 1 year postpartum. Data were collected in 2022 and analyzed in 2023-2024. RESULTS:Of 4,941 individuals, 53% identified as Black non-Hispanic and 21% as Hispanic, 68% were publicly insured, and 93% completed ≥1 health-related social needs screening. Nearly 1 in 4 screened positive for health-related social needs, and 53% linked to ongoing care. Compared with those who screened negative for health-related social needs (n=3,491), linkage to ongoing care was similar among those who screened positive (n=1,079; adjusted risk ratio, aRR=1.04, 95% CI=0.98, 1.10) and lower among those not screened (n=371; aRR=0.77, 95% CI=0.68, 0.86). CONCLUSIONS:Researchers identified a 24% prevalence of pregnancy-related health-related social needs and 53% subsequent linkage to ongoing care. Compared with screening negative for health-related social needs, screening positive was not associated with linkage to care, while being not screened was associated with a 20% lower likelihood of linkage to ongoing care.

Hypertensive disorders of pregnancy (HDPs) are a key contributor to maternal morbidity and mortality. Several gaps in knowledge remain regarding best practices in the postpartum management of HDPs. In this review, we describe postpartum HDPs management among six large academic U.S. hospital systems: Medical College of Wisconsin, University of Pittsburgh, University of Wisconsin-Madison, Northwestern University, University of Minnesota, and Boston Medical Center. We identified that all six health systems discharge patients with HDPs diagnosed with a blood pressure (BP) cuff and use the same two antihypertensive medications, nifedipine and labetalol, as first- and second-line treatment of HDPs. Northwestern University routinely adds oral furosemide for 5 days for patients with BP that exceeds 150/100 mm Hg. Most hospital systems administer magnesium sulfate routinely when readmission for HDPs occurs. In contrast, there was variation in BP threshold for antihypertensive treatment initiation, use of remote BP monitoring program, use of a transition clinic, delivery or lack of education on long-term cardiovascular disease risk, and BP management through the first 6 weeks postpartum and beyond. Based on the clinical review, we identified clinical gaps and formulated considerations for research priorities in the field of postpartum HDPs management. · Several gaps in knowledge remain regarding best practices in postpartum management of HDPs.. · There is a variation in the BP threshold for antihypertensive treatment initiation.. · Data are lacking on the reduction in severe maternal morbidity (SMM) and racial disparities in SMM with remote monitoring..

Background: Previous research has shown pregnant people are not knowledgeable about preeclampsia, a significant cause of maternal morbidity and mortality. This lack of knowledge may impact their ability to report symptoms, comply with rec-ommendations, and receive appropriate follow-up care. Pregnant people commonly seek information from sources outside their treating clinician, including pregnancy-specific books and online sources. We examined commonly used preeclampsia information sources to evaluate whether pregnant people are receiving up-to-date, guideline-based information. Methods: We conducted a content analysis of preeclampsia-related information in top-ranking websites and bestselling pregnancy books. We used American College of Obstetricians and Gynecologists preeclampsia guidelines to construct a codebook, which we used to examine source content completeness and accuracy. For each source, we analyzed infor-mation about preeclampsia diagnosis, patient-reported symptoms, risk factors, prevention, treatment, and complications. Results: Across 19 included sources (13 websites and 6 books), we found substantial variation in completeness and accuracy of preeclampsia information. We found high rates of mentions for preeclampsia symptoms. Risk factors were more commonly included in online sources than book sources. Most sources mentioned treatment options, including blood pressure medication and giving birth; however, one-third of online sources positively mentioned the non -recommended treatment of bed rest. Prevention methods, including prenatal aspirin for high-risk pregnancies, and long-term complications of preeclampsia were infrequently mentioned. Conclusions: Varying rates of accuracy in patient-facing preeclampsia information mean there is substantial room for improvement in these sources. Ensuring pregnant people receive current guideline-based information is critical for improving outcomes and implementing shared decision-making. (c) 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.