Postpartum Course of Gestational Hypertension and Preeclampsia

BACKGROUND: New onset hypertension (gestational hypertension and preeclampsia) complicates 6-8% of pregnancies and usually resolves postpartum, but the time to normalization of blood pressure (BP) in the postpartum period is not known. METHODS: We performed a retrospective cohort study of previously normotensive women who developed gestational hypertension or preeclampsia, and determined the number of weeks postpartum to BP normalization. RESULTS: 62 women with no history of hypertension prior to pregnancy were included, age 35.3 +/- 7.1 years. Hypertension developed at gestational age 15-40 weeks; 45% developed hypertension within 3 days of delivery, 52% developed hypertension 1-22 weeks prior to delivery, and 5% had onset only postpartum. Infants were born at gestational age 35.15 +/- 4.7 weeks. Average BP at treatment initiation was 162/95 mm Hg. Preeclampsia and/or HELLP syndrome was diagnosed in 48%. Most were treated with BP medication in the puerperium. In those whose BP normalized, time to normalization was 5.4 +/- 3.7 weeks. Those who remained hypertensive beyond 6 months (19%) were older (38.8 years vs. 34.4, p = 0.018). Three women had secondary hypertension; primary hyperaldosteronism was diagnosed in 2 women and renovascular hypertension in 1. CONCLUSION: Hypertension presenting in pregnancy normalized postpartum in 81% of this cohort, in most by 3 months. Those who remained hypertensive at 6 months postpartum tended to be older than patients whose BP normalized. Secondary hypertension was detected and surgically corrected in 3 patients. Further studies are needed to characterize those most likely to benefit from postpartum antihypertensive treatment and to guide management.