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Q&A

Hypertension

Poster Session 2

(541) Blood Pressure Threshold to Prevent Post Partum Readmission

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Angela Nakahara, MD

Maternal Fetal Medicine Fellow
Regional Medical Center, Memphis
Memphis, TN, United States

Coauthor(s)

SP

Spencer Pope, MD

University of Tennessee
Memphis, TN, United States
NO

Natalie Oxley, BA, BS, MS

Medical Student
University of Tennessee Health Science Center
Memphis, TN, United States
MW

Morgan Wallen, BS

University of Tennessee
Memphis, TN, United States
CH

Christina Harvey, BS

University of Tennessee
Memphis, TN, United States
JN

Jocelyn Newman, BS

University of Tennessee
Memphis, TN, United States
PG

Patricia Goedecke, MS

Biostatistician
University of Tennessee
Memphis, TN, United States
JW

Jim Wan, PhD

University of Tennessee
Memphis, TN, United States
NM

Norman Meyer, MD

Regional Medical Center, Memphis
Memphis, TN, United States
Kerri Brackney, MD

Maternal Fetal Medicine Physician
University of Tennessee
Memphis, TN, United States

Objective: Ideal postpartum blood pressure (BP) parameters are poorly defined. Improved guidance on BP parameters may help prevent maternal morbidity and mortality. We conducted an exploratory study comparing the BP values in patients readmitted for postpartum preE (PPP) with matched controls to determine BP threshold that is most associated with increased risk of readmission.

Study Design: This is a retrospective case control study comparing women readmitted for PPP to matched controls without readmission between 01/2019 to 03/2022. Cases were matched to controls by age, gestational age and delivery year. BP values in the inpatient postpartum period (e.g., time of delivery to time of discharge) were evaluated. Primary outcome was postpartum BP threshold that would prevent PPP readmission; secondary outcome was proportion of target BP that would prevent PPP readmission. We calculated the proportion of post-partum BP readings below various thresholds and applied logistic regression, identifying area under the curve (AUC) for each threshold. Using the post-partum BP threshold with the highest AUC, we developed confusion matrices at proportions of BPs below the threshold ranging from 0.05 to 1 by 0.05. We observed which proportion had the highest Youden's Index (sensitivity + specificity – 1) to maximize predictive effectiveness.

Results: There were 121 subjects readmitted for PPP and 121 controls. Patients readmitted for PPP were more likely to have HDP (OR 2.43, 95% CI 1.24-4.79), history of HDP (OR 4.02, 95% CI 1.44-11.21), and more likely to have cesarean delivery (OR 1.99, 95% CI 1.18-3.35). We found the BP threshold of 130/80 to have the greatest AUC (0.78) in the logistic prediction of non-readmission. Among proportions of post-partum readings below 130/80, we found 75% to have the highest Youden's Index (SE+SP-1) at 0.47, thus 75% of BPs needed to be below this threshold to minimize readmission risk.

Conclusion: Patients with greater than 25% of postpartum BPs > 130/80 have a higher risk for PPP readmission. Future studies should identify interventions to modify outcomes for patients above this threshold.