Racial Disparity in Postpartum Readmission due to Hypertension among Women with Pregnancy-Associated Hypertension

Abstract

Objective Postpartum hypertension is a leading cause of readmission in the postpartum period. We aimed to examine the prevalence of racial/ethnic differences in postpartum readmission due to hypertension in women with antepartum pregnancy-associated hypertension. Study Design This was a multi-institutional retrospective cohort study of all women with antepartum pregnancy-associated hypertension diagnosed prior to initial discharge from January 2009 to December 2016. Antepartum pregnancy-associated hypertension, such as gestational hypertension, preeclampsia (with or without severe features), hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome, and eclampsia was diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions. Women with chronic hypertension and superimposed preeclampsia were excluded. Our primary outcome was postpartum readmission defined as a readmission due to severe hypertension within 6 weeks of postpartum. Risk factors including maternal age, gestational age at admission, insurance, race/ethnicity (self-reported), type of antepartum pregnancy-associated hypertension, marital status, body mass index (kg/m2), diabetes (gestational or pregestational), use of antihypertensive medications, mode of delivery, and postpartum day 1 systolic blood pressure levels were examined. Multivariable logistic regression models were performed to calculate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs). Results Of 4,317 women with pregnancy-associated hypertension before initial discharge, 66 (1.5%) had postpartum readmission due to hypertension. Risk factors associated with postpartum readmission due to hypertension included older maternal age (aOR = 1.44; 95% CI: 1.20–1.73 for every 5 year increase) and non-Hispanic black race (aOR = 2.12; 95% CI: 1.16–3.87). Conclusion In women with pregnancy-associated hypertension before initial discharge, non-Hispanic black women were at increased odds of postpartum readmission due to hypertension compared with non-Hispanic white women.

Early postpartum readmissions: identifying risk factors at birth hospitalization

“…In this study, the most common diagnosis for readmission within 0 to 6 days was perinatal conditions (complications of pregnancy, childbirth), followed by circulatory systems conditions (including hypertensive disorder) and infectious conditions. Our findings are in line with previous literature demonstrating that infection, 7 , 24 , 25 hypertensive disorders, 7 , 26 , 27 and psychiatric illness 7 are most common indicators for postpartum readmission. Interestingly, the primary diagnoses for readmission between 7 to 29 days after discharge were slightly different from those in the first week with perinatal, infectious, and digestive conditions accounting for 69% of the diagnoses and circulatory causes being less frequently diagnosed than during the early readmission.…”

Racial Disparities in Spine Surgery

“…Importantly, these racial disparities are pervasive across other nonsurgical medical specialties. [70][71][72] Racial disparities across multiple fields of medicine, despite unique differences in procedure and patient populations between medical and surgical subspecialties, suggests that health inequities are pervasive throughout the healthcare system.…”

Best Practices for Managing Postpartum Hypertension

“…Novel research utilizing machine learning has led to the development of risk prediction models for women with HDP that may help individualize care in the postpartum period. Risk factors for postpartum readmission for HDP have previously been identified using a variety of retrospective study designs; these include antecedent HDP, advanced maternal age, multiparity, elevated body mass index, and longer length of labor [ 17 – 19 , 61 ]. More recently, researchers have produced risk prediction models using machine learning that identify readmissions for complications of HDP with reasonable accuracy [ 52 ••].…”

“…Postpartum hypertension due to worsening antenatal HDP is typically easier to diagnose because antenatal disease is a clear risk factor for postpartum disease and patients with antenatal HDP are typically subject to increased surveillance postpartum. Other risk factors for postpartum readmission for hypertension include advanced maternal age, multiparity, elevated body mass index, and longer length of labor [ 17 – 19 ]. While more challenging to diagnose, patients with de novo postpartum hypertension have similar clinical risk factors and antepartum plasma angiogenic profiles to patients with antenatal HDP [ 20 •].…”