Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Hypertension

Poster Session 2

(398) Does Timing of Diagnosis of Hypertensive Disorders of Pregnancy Impact perinatal Outcomes?

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Hypertensive disorders of pregnancy (HDP) can be diagnosed prior to labor starting, during the labor course or postpartum (pp). We sought to evaluate whether the timing of when HDP is diagnosed impacts pp blood pressure (BP) outcomes.

Study Design: This was a secondary analysis of a randomized trial evaluating the efficacy of furosemide on BP outcomes. 384 patients with HDP (including gestational hypertension and preeclampsia with/without severe features) were enrolled at an urban tertiary care hospital between June 2018 to October 2019 with BPs followed for 10 days pp through a text-messaging program. Timing of HDP diagnosis was dichotomized based on distribution of outcomes: Time 1: diagnosed prior to labor or during latent labor; Time 2: diagnosed in active labor or pp. Primary outcome was time to resolution of hypertension (number of days to BP < 140/90 x 2). Secondary outcomes included persistent hypertension 7 days pp and need for antihypertensives pp. Multivariable logistic and Cox regression models were used to estimate associations between timing of HDP and outcomes.

Results: Of 384 subjects, 338 (88%) were diagnosed with HDP at Time 1 and 46 (12%) at Time 2. Compared to those in Time 1, those diagnosed in Time 2 were less likely to have severe preeclampsia (11% vs. 35% p=0.001), were later in gestation (39 vs. 38 wks, p=0.004) and more likely to have a vaginal delivery (98% vs. 73%, p< 0.001), Table. Patients diagnosed at Time 2 had significantly shorter/faster median time to pp BP resolution even after controlling for severity of HDP, mode of delivery and furosemide use (5.5 vs. 6 days, aHR 1.17, 95% CI [1.07 – 1.28]). There was no difference in rate of persistent pp hypertension or need for antihypertensives, Table.

Conclusion: Timing of diagnosis of HDP impacts pp BP resolution. Patients diagnosed with HDP in active labor or postpartum experience a faster time to BP resolution. Our results may have implications for postpartum blood pressure monitoring. Further research targeting the pathways driving these findings should therefore be explored.