(234) Postpartum hypertension and readmission among patients with preeclampsia with severe features

Patients with preeclampsia with severe features (PEC-SF) experience more morbidity postpartum (PP) than those without severe features. Morbidity risk by specific severe feature is unknown. We evaluated the relationship between specific PEC severe feature and number of severe features, and the risk of need for postpartum hypertension care (readmission or outpatient medication management).

Study Design:

This retrospective cohort study included adult patients diagnosed with PEC-SF in two tertiary care centers between 12/2015 and 12/2017. PEC and SF diagnoses were based on ACOG guidelines. The primary outcome was readmission for inpatient HTN management within 0-7, 7-90, or 90-365 days PP. The secondary outcome was need for outpatient HTN therapy adjustment within the same timeframes. Descriptive statistics and multivariate logistic regression models were used to examine associations between severe feature type or number of severe features and outcomes, controlling for age, chronic HTN, diabetes, renal disease, and obesity (BMI >30).

Results:

Of the 774 patients with PEC-SF, 48 (6.2%), 33 (4.3%), and 14 (1.8%) were readmitted in the 0-7, 7-90, and 90-365 days PP timeframes, respectively. Severe range BP was associated with increased risk of readmission within 7 days PP (Table). No other severe criteria were associated with increased risk of readmission at any timeframe. There was no association between individual severe criteria and outpatient PP HTN medication adjustment (Table). There was no association between the number of SFs and the risk of readmission or outpatient medication adjustment (Table).

Conclusion:

Readmission within 1 week PP was more common in patients with a diagnosis of PEC-SF by blood pressure than by other severe features of preeclampsia. The specific criteria and number of criteria used to diagnose PEC-SF did not influence the development of worsening HTN requiring outpatient management in the PP period. Our findings emphasize the importance of close follow-up of patients with PEC-SF during the first week PP.