Postpartum health-care utilization and blood pressure control by antihypertensive agent in hypertensive disorders of pregnancy.

backgroundHypertensive disorders of pregnancy are a significant contributor to maternal morbidity and mortality in the postpartum period and are the leading cause of postpartum readmission following delivery hospitalization. At present, there remains uncertainty regarding differences in postpartum health care utilization for individuals discharged on specific antihypertensive agents while enrolled in an institutional remote blood pressure (BP) monitoring program.

objectiveTo evaluate rates of postpartum hospital readmission and emergency room (ER) utilization for individuals with a hypertensive disorder of pregnancy (HDP) enrolled in remote BP monitoring after discharge on labetalol vs nifedipine. STUDY

designWe performed a retrospective cohort study to evaluate outcomes associated with the type of antihypertensive medication at discharge in postpartum individuals delivering between April 2019 and June 2023 at a single institution. The exposure of interest was discharge on single-agent labetalol vs nifedipine. Individuals were included who were diagnosed with hypertension (HTN) in pregnancy (including pre-pregnancy HTN) and were enrolled in our institution's remote BP management program. Our institution's remote program monitors BP up to 6 months postpartum. Individuals were excluded if they were prescribed antihypertensives antenatally. We compared demographics, clinical outcomes, and home BP measures between groups. The primary outcome was postpartum hospital readmission and ER visits within 8 weeks of delivery. Multivariate logistic regression models adjusted for severity of HDP, TIS, race, and BMI.

results1507 individuals were included; 488 (32.4%) were discharged on labetalol and 1019 (67.6%) on nifedipine. Those discharged on labetalol had higher BMIs and higher rates of pre-pregnancy HTN. Compared to individuals discharged on labetalol, those discharged on nifedipine were less likely to have a postpartum hospital readmission (9.2% vs 3.9%, P<.001). In multivariate logistic regression models, discharge on labetalol was associated with a significant increased odds of postpartum hospital readmission [aOR 2.70 (95% CI 1.57-4.65)] but not ED visits [aOR 1.01 (95% CI 0.67-1.52)] compared with discharge on nifedipine. These findings were similar with stratification by pre-pregnancy HTN. Upon analysis of home postpartum BP data, we found that the proportion of blood pressures in the severe range by each postpartum day was higher in the first ten days postpartum for those discharged on labetalol as compared to nifedipine.

conclusionDischarge on labetalol was associated with an increased odds of postpartum hospital readmission following a HDP compared with discharge on nifedipine. Our findings suggest this may be driven by more severe hypertension on home monitoring by each day postpartum in the first ten days postpartum.