Factors Associated with Early Readmission for Postpartum Hypertension

Background Hypertensive disorders of pregnancy are increasing in prevalence and a leading cause of early post-partum readmissions. Stricter blood pressure (BP) target goals for treatment of hypertension during pregnancy have recently been proposed, however, the treatment goals for management of post-partum hypertension are less well established. Objective We sought to evaluate the clinical factors associated with early postpartum readmissions for hypertensive disease as well as to evaluate blood pressure thresholds associated with these readmissions. Study design We conducted a retrospective cohort study of women delivering at a tertiary care center between January 2018 and May 2022 who experienced a hospital readmission for postpartum hypertension or new onset postpartum preeclampsia. Charts were reviewed for clinical and sociodemographic data. Patients with early readmission (<72 hours after discharge) were compared with patients readmitted after three days of initial discharge. Data were analyzed using Chi-square, Student's t-test, Mann-Whitney U test, and logistic regression where appropriate. The p-value <0.05 was significant. Results During the study period, 23,372 deliveries occurred. Postpartum readmission due to worsening of a known diagnosis of hypertension or new onset postpartum preeclampsia occurred in 1.1% and 0.49% respectively. Patients with early readmission were more likely to have hypertensive disorders of pregnancy (HDP) as the indication for delivery. Among patients readmitted, 93% had two or more systolic BP ≥ 140 or diastolic BP ≥ 90, and 73% had blood pressure of either systolic between 130-139 or diastolic between 80-89 within 24 hours prior to initial discharge. Only 27 patients met criteria (BP ≥ 160/110 on more than one vitals check during their hospitalization) to be started on antihypertensives prior to initial delivery discharge; of those 25 (93%) were discharged with a new prescription for an antihypertensive. After controlling for confounding variables, predischarge blood pressure between 130-140/80-90 mmHg [aOR 2.4(1.5-4.0] was associated with an increased likelihood of early readmission. Conclusions Patients with delivery for HDP and predischarge BP ≥140/90 mmHg were less likely to have an early readmission within 3 days of initial discharge, however, patients with predischarge BP 130-139/80-89 were more likely to have an early readmission for HDP and postpartum preeclampsia. Further research is indicated to evaluate interventions to prevent postpartum readmission in patients at high risk for persistent hypertension or new onset postpartum preeclampsia.