Incidence and Risk Factors of De Novo Postpartum Hypertension

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BACKGROUND: Individuals developing hypertensive disorders of pregnancy face a 2- to 5-fold risk of long-term cardiovascular disease. Limited data exist on de novo postpartum hypertension (dnPPHTN), where those normotensive during pregnancy develop hypertension immediately postpartum. Under-recognition of dnPPHTN can lead to severe morbidity due to delayed or absent treatment and missed opportunities for mitigating long-term cardiovascular disease risk. OBJECTIVES: The aim of the study was to estimate the incidence of dnPPHTN and identify demographic and clinical risk factors for its development. METHODS: This retrospective cohort study analyzed 506 postpartum individuals delivering at a tertiary care institution over 1 month. Participants were classified as: 1) normotensive; or 2) dnPPHTN, defined as systolic blood pressure (BP) ≥140 mm Hg and/or diastolic BP ≥90 mm Hg on at least 2 occasions up to 6 weeks postpartum after a normotensive pregnancy. We excluded those with prepregnancy or antepartum hypertensive disorders. Demographic and clinical characteristics were compared using adjusted logistic regression models. RESULTS: Of 389 included participants, 35 (9.0%) developed dnPPHTN. Of these, 5.7% had pregestational diabetes compared to 0.6% of normotensive individuals (P = 0.042; adjusted OR: 11.3; 95% CI: 1.8-73.1). Early prenatal diastolic BP was higher in the dnPPHTN group (72.2 vs 68.4 mm Hg, P = 0.008), though this difference did not persist after adjustment. Medication-dependent gestational diabetes mellitus (ie, A2GDM) was associated with dnPPHTN (adjusted OR: 6.1; 95% CI: 1.2-30.1). CONCLUSIONS: Pregestational diabetes and A2GDM are associated with dnPPHTN. Closer follow-up for BP monitoring postpartum and more urgent transitions of care for ongoing medical management may reduce long-term cardiovascular risk.

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