(1029) Postpartum preeclampsia readmissions- Is de novo postpartum hypertension worse?

To determine if maternal outcomes vary between individuals readmitted with de novo postpartum hypertension compared to individuals with underlying hypertensive disease of pregnancy.

Study Design:

This is a retrospective cohort analysis of postpartum preeclampsia readmission (up to 6 weeks postpartum) between 2017-2023 at a tertiary medical center. Subjects were stratified based on underlying hypertensive status: 1. de novo postpartum hypertension (de novo PP HTN) and 2. those with a known diagnosis of hypertensive disorder of pregnancy or chronic hypertension (HDP). Our primary outcome was composite maternal morbidity: acute kidney injury, pulmonary edema, stroke, eclampsia, ICU admission, maternal death, and thromboembolism. Data were analyzed using Chi-squared and Fisher’s exact tests for categorical variables and Poisson regression model was used for calculating relative risk.

Results:

Of 359 included subjects, 83 (23%) had de novo PP HTN; 276 (77%) had HDP. Individuals with HDP had higher rates of obesity, diabetes mellitus, and a history of preeclampsia in prior pregnancies (Table 1).  Composite maternal outcomes did not differ between the groups (P=0.324), however rates of stroke and ICU admission during readmission were increased among individuals with de novo PP HTN (4.8% vs 0.4%, p= 0.01; and 6% vs 1.8%, p=0.04) (Table 1). Time from delivery discharge to readmission and length of stay during readmission were not different between the groups (Table 1).

Conclusion:

Individuals readmitted with de novo PP HTN and those with HDP have similar composite maternal morbidity, however rates of stroke and ICU admission are increased among those with de novo PP HTN. Thus, there is a need to identify risk factors for de novo PP HTN in order to facilitate closer monitoring postpartum in this population.