Can we predict the need for antihypertensive treatment during the early postpartum period for women with preeclampsia or gestational hypertension?

Abstract

Objectives: To determine factors that predict the need for antihypertensive treatment during early postpartum period among women with preeclampsia or gestational hypertension.

Study design: Retrospective cohort of 358 women.

Main outcome measures: Demographic, clinical and laboratory data of 63 women diagnosed with preeclampsia or gestational hypertension during a singleton pregnancy and who needed antihypertensive agents during early postpartum period were compared to 295 who did not.

Results: No difference was found between groups regarding age, parity, body mass index, or weight gain (p = 0.95, 0.19, 0.56, and 0.078, respectively). Early onset preeclampsia or gestational hypertension was diagnosed among 28.6% of the women who subsequently needed antihypertensive treatment, as compared to 4.1% who did not (p < 0.001). Antepartum, mean maximum blood pressure in the treated vs. untreated group was 165/109 mmHg vs. 150/100 mmHg, respectively (p = 0.001). Groups did not differ regarding symptoms of preeclampsia (38.7% vs. 31.5%, p = 0.273) or laboratory abnormalities. The group that received antihypertensive treatment during early postpartum period, had more preterm deliveries (p < 0.001) and Cesarean deliveries (p < 0.001), and more received magnesium sulfate during labor (p < 0.001). During the early postpartum period, mean maximum blood pressure was higher among the treated group (167/106 vs. 143/92, p = 0.001), as were symptoms of preeclampsia (p = 0.001). The groups were similar regarding laboratory abnormalities that define preeclampsia.

Conclusions: Early onset preeclampsia or gestational hypertension, severe antepartum hypertension, magnesium sulfate during labor, preterm, and Cesarean delivery might be good predictors of the need for antihypertensive treatment during early postpartum period.

Keywords: Antihypertensive treatment; Early postpartum period; Gestational hypertension; Hypertension in pregnancy; Preeclampsia.