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Am J Perinatol 2025; 42(11): 1371-1380
DOI: 10.1055/a-2416-5974
Review Article

Postpartum Management of Hypertensive Disorders of Pregnancy in Six Large U.S. Hospital Systems: Descriptive Review and Identification of Clinical and Research Gaps

Anna Palatnik 
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
2   Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Alisse Hauspurg
3   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
4   Magee-Womens Research Institute, Pittsburgh, Pennsylvania
,
Kara K. Hoppe
5   Departmeent of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
,
Lynn M. Yee
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Jacqueline Kulinski
2   Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Sadiya S. Khan
7   Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
8   Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Bethany Sabol
9   Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota
,
Christina D. Yarrington
10   Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
,
Priya M. Freaney
7   Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Samantha E. Parker
11   Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
› Author Affiliations
Funding A.P. is supported by the National Heart Lung and Blood Institute (NHLBI; grant no.: R34HL165013) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant no.: R01HD112930). A.H. is supported by the NHLBI (grant no.: K23HL16835). L.M.Y. is supported by the NICHD (grant no.: R01 HD098178).
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Abstract

Hypertensive disorders of pregnancy (HDPs) are a key contributor to maternal morbidity and mortality. Several gaps in knowledge remain regarding best practices in the postpartum management of HDPs. In this review, we describe postpartum HDPs management among six large academic U.S. hospital systems: Medical College of Wisconsin, University of Pittsburgh, University of Wisconsin–Madison, Northwestern University, University of Minnesota, and Boston Medical Center. We identified that all six health systems discharge patients with HDPs diagnosed with a blood pressure (BP) cuff and use the same two antihypertensive medications, nifedipine and labetalol, as first- and second-line treatment of HDPs. Northwestern University routinely adds oral furosemide for 5 days for patients with BP that exceeds 150/100 mm Hg. Most hospital systems administer magnesium sulfate routinely when readmission for HDPs occurs. In contrast, there was variation in BP threshold for antihypertensive treatment initiation, use of remote BP monitoring program, use of a transition clinic, delivery or lack of education on long-term cardiovascular disease risk, and BP management through the first 6 weeks postpartum and beyond. Based on the clinical review, we identified clinical gaps and formulated considerations for research priorities in the field of postpartum HDPs management.

Key Points

  • Several gaps in knowledge remain regarding best practices in postpartum management of HDPs.

  • There is a variation in the BP threshold for antihypertensive treatment initiation.

  • Data are lacking on the reduction in severe maternal morbidity (SMM) and racial disparities in SMM with remote monitoring.

Keywords

hypertensive disorders of pregnancy - postpartum - remote monitoring - antihypertensive treatment

Note

Each author has indicated that he/she has met the journal's requirements for authorship.




Publication History

Received: 31 March 2024

Accepted: 17 September 2024

Article published online:
10 October 2024

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