Persistent Hypertension Up to One Year Postpartum among Women with Hypertensive Disorders in Pregnancy in a Low-Resource Setting: A Prospective Cohort Study

Abstract

Background: Hypertensive disorders in pregnancy (HDPs) are associated with lifelong cardiovascular disease risk. Persistent postpartum hypertension in HDPs could suggest progression to chronic hypertension. This phenomenon has not been well examined in low-and middle-income countries (LIMCs), and most previous follow-ups typically last for maximally six weeks postpartum. We assessed the prevalence of persistent hypertension up to one year in women with HDPs in a low resource setting and determined associated risk factors. Methodology: A prospective cohort study of women conducted at eight tertiary health care facilities in seven states of Nigeria. Four hundred and ten women with any HDP were enrolled within 24 hours of delivery and followed up at intervals until one year postpartum. Descriptive statistics were performed to express the participants' characteristics. Univariable and multivariable logistic regressions were conducted to identify associated risk factors. Results: Of the 410 women enrolled, 278 were followed up to one year after delivery (follow-up rate 68%). Among women diagnosed with gestational hypertension and pre-eclampsia/ eclampsia, 22.3% (95% CI; 8.3-36.3) and 62.1% (95% CI; 52.5-71.9), respectively, had persistent hypertension at six months and this remained similar at one year 22.3% (95% CI; 5.6-54.4) and 61.2% (95% CI; 40.6-77.8). Maternal age and body mass index were significant risk factors for persistent hypertension at one year [aORs = 1.07/year (95% CI; 1.02-1.13) and 1.06/kg/m 2 (95% CI; 1.01-1.10)], respectively. Conclusion: This study showed a substantial prevalence of persistent hypertension beyond puerperium. Health systems in LMICs need to be organized to anticipate and maintain postpartum monitoring until blood pressure is normalized, or women referred or discharged to family physicians as appropriate. In particular, attention should be given to women who are obese, and or of higher maternal age.

Hypertensive disorders of pregnancy and cardiovascular disease risk across races and ethnicities, a review

“…Three months to 1 year after pregnancy, the prevalence of hypertension among Indian, Cameroonian, Ugandan, Cuban, and Black Dutch women with PE was 15-38%; among Kenyan women with GH/PE prevalence of hypertension was 24% (91,101,102,112,114,120). Prevalence of hypertension was 22% 1 year after pregnancy in Nigerian women with GH, and 61% in women with PE (98).…”

Hypertensive Disorders of Pregnancy and Cardiovascular Disease Risk Across Races and Ethnicities: A Review

“…Three months to 1 year after pregnancy, the prevalence of hypertension among Indian, Cameroonian, Ugandan, Cuban, and Black Dutch women with PE was 15–38%; among Kenyan women with GH/PE prevalence of hypertension was 24% ( 91 , 101 , 102 , 112 , 114 , 120 ). Prevalence of hypertension was 22% 1 year after pregnancy in Nigerian women with GH, and 61% in women with PE ( 98 ).…”

“…The majority of the studies reported on the risk of hypertension after a pregnancy complicated by HDP ( n = 42; Supplementary Table 6A ) ( 81 – 83 , 86 , 87 , 89 – 94 , 97 , 98 , 101 – 106 , 109 – 120 , 122 – 124 , 128 , 132 – 134 , 138 , 139 ). All but one of the comparative studies showed a significantly increased risk of hypertension after pregnancy complicated by HDP, although follow-up time, absolute prevalence/incidence, and risk ratios differed substantially across different studies.…”

C677T Gene Polymorphism of MTHFR Is a Risk Factor for Impaired Renal Function in Pregnant Women With Preeclampsia in the Chinese Han Population

“…Hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH), preeclampsia-eclampsia (PE), pregnancy-associated chronic hypertension and chronic hypertension with superimposed preeclampsia ( 1 ), are idiopathic diseases of pregnancy, posing serious threats to the health of mothers and infants. The incidence of PE in developing countries such as China is higher than that in developed countries ( 2 ). Since pregnancy is a special physiological process, hypertension and other diseases with specific occurrences in pregnancy deserve special attention.…”