Association between Peripartum Mean Arterial Pressure and Postpartum Readmission for Preeclampsia with Severe Features

Bing-Xue Lin; Maria Smith; Megan Sutter; Christina A Penfield; Christine Proudfit

doi:10.1055/s-0043-1770705

Association between Peripartum Mean Arterial Pressure and Postpartum Readmission for Preeclampsia with Severe Features

Am J Perinatol. 2023 Jun 29. doi: 10.1055/s-0043-1770705. Online ahead of print.

Authors

Bing-Xue Lin¹, Maria Smith², Megan Sutter³, Christina A Penfield⁴, Christine Proudfit⁵

Affiliations

¹ Franciscan Women's Health Associates, Tacoma, Washington.
² Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York.
³ Rollins School of Public Health, Emory University, Atlanta, Georgia.
⁴ Department of Obstetrics & Gynecology, New York University Langone Health,, New York, New York.
⁵ Section of Maternal-Fetal Medicine, Cleveland Clinic, Cleveland, Ohio.

PMID: 37385293
DOI: 10.1055/s-0043-1770705

Abstract

Objective: This study aimed to evaluate the relationship between peripartum mean arterial pressure (MAP) and postpartum readmission for preeclampsia with severe features.

Study design: This is a retrospective case-control study comparing adult parturients readmitted for preeclampsia with severe features to matched nonreadmitted controls. Our primary objective was to evaluate the association between MAP at three time points during the index hospitalization (admission, 24-hour postpartum, and discharge) and readmission risk. We also evaluated readmission risk by age, race, body mass index, and comorbidities. Our secondary aim was to establish MAP thresholds to identify the population at highest risk of readmission. Multivariate logistic regression and chi-squared tests were used to determine the adjusted odds of readmission based on MAP. Receiver operating characteristic analyses were performed to evaluate risk of readmission relative to MAP; optimal MAP thresholds were established to identify those at highest risk of readmission. Pairwise comparisons were made between subgroups after stratifying for history of hypertension, with a focus on readmitted patients with new-onset postpartum preeclampsia.

Results: A total of 348 subjects met inclusion criteria, including 174 controls and 174 cases. We found that elevated MAP at both admission (adjusted odds ratio [OR]: 1.37 per 10 mm Hg, p < 0.0001) and 24-hour postpartum (adjusted OR: 1.61 per 10 mm Hg, p = 0.0018) were associated with increased risk of readmission. African American race and hypertensive disorder of pregnancy were independently associated with increased risk of readmission. Subjects with MAP > 99.5 mm Hg at admission or >91.5 mm Hg at 24-hour postpartum had a risk of at least 46% of requiring postpartum readmission for preeclampsia with severe features.

Conclusion: Admission and 24-hour postpartum MAP correlate with risk of postpartum readmission for preeclampsia with severe features. Evaluating MAP at these time points may be useful for identifying women at higher risk for postpartum readmission. These women may otherwise be missed based on standard clinical approaches and may benefit from heightened surveillance.

Key points: · Existing literature focuses on management of antenatal hypertensive disorders of pregnancy.. · Elevated peripartum MAP is associated with increased odds of readmission for preeclampsia.. · Peripartum MAP may predict readmission risk for de novo postpartum preeclampsia..