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Am J Perinatol
DOI: 10.1055/a-2591-8090
Original Article

Association between Elevated Postnatal Blood Pressure and Postpartum Acute Care Utilization in a Southeastern U.S. Health Care System, 2021 to 2023

Clara E. Busse
1   Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
2   Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Catherine J. Vladutiu
3   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Brian W. Pence
4   Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Christine Tucker
1   Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Katherine Tumlinson
2   Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
5   Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Alison M. Stuebe
1   Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
3   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
› Author Affiliations
Funding This research was supported in part by a training grant from the National Institute of Child Health and Development (T32 HD052468). This research was also supported by the Agency for Healthcare Research and Quality (AHRQ; R18HS027260), the Postnatal Patient Safety Learning Lab. CEB was supported by the Population Research Infrastructure Program (P2C HD050924) awarded to the Carolina Population Center at The University of North Carolina at Chapel Hill. The funding sources had no involvement in the study design, interpretation, or analysis, or in the decision to submit the article for publication.
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Abstract

Objective

Hypertensive disorders of pregnancy are a leading cause of pregnancy-related deaths in the United States and approximately 70% occur after birth. We estimated the crude and adjusted association between elevated postnatal blood pressure (BP) and acute care utilization (visits to the Emergency Department, obstetric triage, urgent care facility, or hospital readmission) in the first 12 weeks after discharge from the birth hospitalization.

Study Design

We constructed a retrospective cohort of birthing people aged ≥18 years who gave birth to ≥1 liveborn infant at >20 weeks of gestation from July 1, 2021, to December 31, 2022, at a quaternary maternity hospital in the Southeastern United States using electronic health records. Elevated BP was defined as ≥3 values of systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg between birth and discharge from the birth hospitalization. Crude and adjusted multivariable binomial regression models estimated risk differences comparing the 12-week risk of the postpartum acute care utilization (PACU) outcomes among birthing people with elevated postnatal BP to those without.

Results

In this cohort of 6,041 birthing people, 13.3% (n = 804) had any PACU within 12 weeks of discharge from the birth hospitalization. The unadjusted 12-week risk of PACU was 6.5 percentage points higher among those with elevated postnatal BP compared to those without (95% confidence interval [CI]: 4.7 and 8.4). After adjusting for potential confounders, the 12-week risk of PACU was 6.0 percentage points higher among those with elevated postnatal BP compared to those without (95% CI: 4.2 and 7.8).

Conclusion

Postnatal BP is a simple indicator of postpartum health status that may be used to flag individuals in need of more intensive postpartum counseling and follow-up.

Key Points

  • Elevated postnatal BP is associated with postpartum acute care use.

  • People used acute care for BP-related reasons and reasons not related to BP.

  • Tracking postnatal BPs may be a simple way to find people who need extra support.

Keywords

blood pressure - hypertension - acute care - emergency department - hospital readmission - obstetric triage - postpartum - maternal health

Note

The content is solely the responsibility of the authors and does not necessarily present the official views of AHRQ or DHHS.


Supplementary Material



Publication History

Received: 18 December 2024

Accepted: 20 April 2025

Article published online:
19 May 2025

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