Key result
Pre-eclampsia/eclampsia linked to ~61% rate of persistent hypertension at one year postpartum.
Why the study?
Persistent postpartum hypertension in hypertensive disorders in pregnancy has not been well examined in low- and middle-income countries, where prior follow-ups typically lasted at most six weeks postpartum.
Cohort (n=410)
Yes
Absolute Event Rate: 61.2% vs 22.3%
A substantial proportion of women with hypertensive disorders in pregnancy, particularly those with pre-eclampsia/eclampsia, obesity, or higher maternal age, experience persistent hypertension up to one year postpartum in low-resource settings.
May warrant postpartum hypertension screening after pre-eclampsia; leaves optimal interventions open in low-resource settings.
Background: Hypertensive disorders in pregnancy (HDPs) are associated with lifelong cardiovascular disease risk. Persistent postpartum hypertension in HDPs could suggest progression to chronic hypertension. This phenomenon has not been well examined in low- and middle-income countries (LIMCs), and most previous follow-ups typically last for maximally six weeks postpartum. We assessed the prevalence of persistent hypertension up to one year in women with HDPs in a low resource setting and determined associated risk factors. Methodology: A prospective cohort study of women conducted at eight tertiary health care facilities in seven states of Nigeria. Four hundred and ten women with any HDP were enrolled within 24 hours of delivery and followed up at intervals until one year postpartum. Descriptive statistics were performed to express the participants’ characteristics. Univariable and multivariable logistic regressions were conducted to identify associated risk factors. Results: Of the 410 women enrolled, 278 were followed up to one year after delivery (follow-up rate 68%). Among women diagnosed with gestational hypertension and pre-eclampsia/eclampsia, 22.3% (95% CI; 8.3–36.3) and 62.1% (95% CI; 52.5–71.9), respectively, had persistent hypertension at six months and this remained similar at one year 22.3% (95% CI; 5.6–54.4) and 61.2% (95% CI; 40.6–77.8). Maternal age and body mass index were significant risk factors for persistent hypertension at one year [aORs = 1.07/year (95% CI; 1.02–1.13) and 1.06/kg/m2 (95% CI; 1.01–1.10)], respectively. Conclusion: This study showed a substantial prevalence of persistent hypertension beyond puerperium. Health systems in LMICs need to be organized to anticipate and maintain postpartum monitoring until blood pressure is normalized, or women referred or discharged to family physicians as appropriate. In particular, attention should be given to women who are obese, and or of higher maternal age.
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Ishaku et al. (2021) conducted a cohort in Hypertensive disorders in pregnancy (n=410). Pre-eclampsia/eclampsia vs. Gestational hypertension was evaluated on persistent hypertension at one year. Pre-eclampsia/eclampsia and gestational hypertension were associated with persistent hypertension at one year in 61.2% and 22.3% of women, respectively.
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