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Q&A

Hypertension

Poster Session 4

(962) Social determinants of health impact the development of new-onset postpartum hypertension

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Hypertension (HTN) that is diagnosed postpartum (ppHTN) is understudied. Although more commonly diagnosed in women with hypertensive disorders of pregnancy (HDP), it can occur de novo postpartum (PP). There are no guidelines for BP surveillance after normotensive pregnancies; therefore, data on the incidence and risk factors for new-onset ppHTN is limited. We aimed to prospectively examine incidence and risk factors for ppHTN, and the impact of social determinants of health (SDoH).

Study Design: We performed a secondary analysis of participants without chronic HTN or HDP (n=244) from the coronaVirus Impact on Birth Equity (VIBE) Study, which enrolled patients in 2022 from four hospitals in Philadelphia and New York City. Participants reported PP BP on a text-messaging platform for 90 days and provided demographic and SDoH information via survey. The primary outcome was Stage 1 or Stage 2 ppHTN defined as ≥2 BP ≥130/80 or receiving new medications or diagnosis of HTN within 12 weeks PP. We examined SDoH measures and their impact on ppHTN diagnosis including rent/food insecurity, housing status, education, gendered racial microaggressions during obstetric care, postpartum visit attendance, neighborhood racial-economic segregation, language, race, ethnicity, and nativity. Multivariable logistic regression was used to adjust for BMI, parity and age.

Results: 71 (29.1%) participants met criteria for Stage 1 ppHTN, 5 (2.1%) met criteria for Stage 2 ppHTN, and 3 (1.2%) received new medication or diagnosis for HTN. Those in highly segregated neighborhoods were more likely to develop ppHTN compared to those in less segregated neighborhoods (unadjusted OR: 1.97, 95% CI: 1.07, 3.73). This finding was sustained after adjusting for BMI, parity, age, and all other SDoH (aOR: 2.21, 95% CI: 1.06, 4.64). The only other risk factor identified was BMI (aOR: 1.09, 95% CI: 1.04, 1.15).

Conclusion: In a diverse low-risk population, 32.4% of participants developed new-onset ppHTN. Higher BMI and living in highly segregated neighborhoods were significantly associated with the development of new-onset ppHTN.