Clinical Course, Associated Factors, and Blood Pressure Profile of Delayed-Onset Postpartum Preeclampsia

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 134; no. 5; pp. 995 - 1001
• Main Authors: Redman, Emily K, Hauspurg, Alisse, Hubel, Carl A, Roberts, James M, Jeyabalan, Arun
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.11.2019
• Subjects: Adult; Antihypertensive Agents - therapeutic use; Case-Control Studies; Disease Progression; Female; Humans; Hypertension - drug therapy; Hypertension - epidemiology; Patient Readmission - statistics & numerical data; Postpartum Period - ethnology; Postpartum Period - physiology; Pre-Eclampsia - diagnosis; Pre-Eclampsia - epidemiology; Pre-Eclampsia - physiopathology; Pre-Eclampsia - therapy; Pregnancy; Prognosis; Puerperal Disorders - diagnosis; Puerperal Disorders - epidemiology; Puerperal Disorders - physiopathology; Puerperal Disorders - therapy; Risk Factors; United States; United States
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000003508

OBJECTIVE:To identify clinical risk factors associated with development of delayed-onset postpartum preeclampsia, and to characterize management and subsequent risk of cardiovascular disease. METHODS:This is a case–control study of women admitted to the hospital with delayed-onset postpartum preeclampsia (defined as a new diagnosis of preeclampsia presenting between 48 hours and 6 weeks postpartum) compared with women with full-term, uncomplicated pregnancies without a hypertensive diagnosis or diabetes. Included women delivered between January 2014 and June 2018 at a single tertiary care center. Women with an antenatal diagnosis of preeclampsia or chronic hypertension were excluded. Univariate analysis was used to identify risk factors associated with delayed-onset postpartum preeclampsia and to compare rates of hypertension and antihypertensive medication use, with follow-up beyond 3 months postpartum among a subset of women in the control group who were matched 2:1 with women in the case group. Multivariable logistic regression was performed and included covariates identified in a backward stepwise approach. RESULTS:Compared with women in the control group (n=26,936), women with delayed-onset postpartum preeclampsia (n=121) were significantly more likely to be of non-Hispanic black race (31.4% vs 18.0%), obese (39.7% vs 20.1%), and deliver by cesarean (40.5% vs 25.8%), all P<.01. For women diagnosed with delayed-onset postpartum preeclampsia, the median postpartum day of presentation was 7.0 (interquartile range 5.0–9.0), with 93.4% presenting secondary to symptoms, which was most commonly a headache. A majority (73.6%) underwent imaging studies, and 49.6% received intravenous antihypertensive agents. A total of 86 (71.0%) women with delayed-onset postpartum preeclampsia and 169 (72.8%) women in the control group had longer term information available, with a median follow-up time of 1.5 years (interquartile range 0.8–2.8). Delayed-onset postpartum preeclampsia was associated with higher blood pressures at 3 months postpartum or later (median systolic 130 mm Hg vs 112 mm Hg and median diastolic 80 mm Hg vs 70 mm Hg, P<.001). CONCLUSION:Delayed-onset postpartum preeclampsia is associated with variable management strategies. There is substantial overlap between the clinical risk factors for delayed-onset postpartum preeclampsia and antepartum preeclampsia. Our findings suggest that delayed-onset postpartum preeclampsia is also associated with an increased risk of progression to chronic hypertension.