Factors Associated with Postpartum Readmission for Hypertensive Disorders of Pregnancy.

Postpartum readmission (PPR) has negative implications for patients and health systems. Prior studies suggest that up to 5% of women with hypertensive disorders of pregnancy (HDP) experience PPR. Studies examining factors associated with PPR for hypertension have had small sample sizes and conflicting results.
To characterize the incidence of and risk factors for PPR for HDP among a cohort of women with preexisting HDP.
Retrospective cohort study of pregnant women with known HDP who delivered live births in a large managed care organization in 2018. The primary outcome was hospital readmission for a hypertensive diagnosis or stroke within 42 days of delivery. The primary exposure of interest was persistent postpartum hypertension, defined as maximum systolic blood pressure (SBP) ≥140 mmHg or maximum diastolic blood pressure (DBP) ≥90 mmHg in the 24 hours prior to discharge from delivery hospitalization. Continuous and categorical variables were compared with bivariate analysis. Risk factors independently associated with PPR were identified using multivariable logistic regression.
Of 42,022 women who delivered in 2018, 7,151 had HDP-an incidence of 17%. PPR rate among women with HDP was 4.43% (317/7,151). The following risk factors were associated with increased odds of PPR in women with HDP: SBP ≥140 in the 24 hours prior to discharge (adjusted odds ratio (aOR) 2.29, 95% confidence interval (CI) 1.71-3.07), DBP ≥90 in the 24 hours prior to discharge (aOR 1.33, CI 1.02-1.73), maternal age ≥30 (30-34: aOR 1.57, CI 1.12-2.19; 35-39: aOR 2.36, CI 1.70-3.28; ≥40: aOR 2.95, CI 1.95-4.46), receipt of magnesium sulfate (aOR 1.47, CI 1.11-1.94), and receipt of inpatient rapid-acting antihypertensive medication (aOR 1.46, CI 1.10-1.93). One BP ≥140/90 in the 24 hours prior to discharge increased the odds of readmission (aOR 1.98, CI 1.37-2.87). Two or more elevated BP values further increased odds (aOR 3.14, CI 2.33-4.24). Median postpartum day of readmission was 5 (interquartile range=3).
Hospital readmission for postpartum hypertension was associated with persistent postpartum hypertension (BP ≥140/90), increasing maternal age, and more severe antepartum hypertension. Women with these characteristics may be targeted in future quality initiatives to mitigate readmission.

Copyright © 2021. Published by Elsevier Inc.