Risk factors associated with attendance at postpartum blood pressure follow-up visit in discharged patients with hypertensive disorders of pregnancy

Li et al. BMC Pregnancy and Childbirth (2023) 23:485 https://doi.org/10.1186/s12884-023-05780-6 BMC Pregnancy and Childbirth Open Access RESEARCH Risk factors associated with attendance at postpartum blood pressure follow-up visit in discharged patients with hypertensive disorders of pregnancy Jingjing Li1, Qin Zhou1, Yixuan Wang1, Lufen Duan1, Guangjuan Xu1, Liping. Zhu2, Liping Zhou2, Lan Peng2*, Lian. Tang1* and Yanxia. Yu3* Abstract Background This study aims to investigate the risk factors for not returning to postpartum blood pressure (BP) follow-up visit at different time points in postpartum discharged hypertensive disorders of pregnancy (HDP) patients. Likewise, females with HDP in China should have a BP evaluation continuously for at least 42 days postpartum and have BP, urine routine, and lipid and glucose screening for 3 months postpartum. Methods This study is a prospective cohort study of postpartum discharged HDP patients. Telephone follow-up was conducted at 6 weeks and 12 weeks postpartum, the maternal demographic characteristics, details of labor and delivery, laboratory test results of patients at admission, and adherence to BP follow-up visits postpartum were collected. While logistic regression analysis was used to analyze the factors associated with not returning to postpartum BP follow-up visit at 6 weeks and 12 weeks after delivery, the receiver operating characteristic (ROC) curve was drawn to evaluate the model’s predictive value for predicting not returning to postpartum BP visit at each follow-up time point. Results In this study, 272 females met the inclusion criteria. 66 (24.26%) and 137 (50.37%) patients did not return for postpartum BP visit at 6 and 12 weeks after delivery. A multivariate logistic regression analysis identified education level of high school or below (OR = 3.71; 95% CI = 2.01–6.85; p = 0.000), maximum diastolic BP during pregnancy (OR = 0.97; 95% CI = 0.94–0.99; p = 0.0230)and delivery gestational age (OR = 1.12; 95% CI = 1.005–1.244; p = 0.040)as independent risk factors in predicting not returning to postpartum BP follow-up visit at 6 weeks postpartum, and education level of high school or below (OR = 3.20; 95% CI = 1.805–5.67; p = 0.000), maximum diastolic BP during pregnancy (OR = 0.95; 95% CI = 0.92–0.97; p = 0.000), delivery gestational age (OR = 1.13; 95% CI = 1.04–1.24; p = 0.006) and parity (OR = 1.63; 95% CI = 1.06–2.51; p = 0.026) as risk factors for not returning to postpartum BP follow-up visit *Correspondence: Lan Peng Lian. Tang Yanxia. Yu Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Li et al. BMC Pregnancy and Childbirth (2023) 23:485 Page 2 of 9 at 12 weeks postpartum. The ROC curve analysis indicated that the logistic regression models had a significant predictive value for identify not returning to BP follow-up visit at 6 and 12 weeks postpartum with the area under the curve (AUC) 0.746 and 0.761, respectively. Conclusion Attendance at postpartum BP follow-up visit declined with time for postpartum HDP patients after discharge. Education at or below high school, maximum diastolic BP during pregnancy and gestational age at delivery were the common risk factors for not returning for BP follow-up visit at 6 and 12 weeks postpartum in postpartum HDP patients. Keywords Hypertension in pregnancy, Predictors, Postpartum, Blood pressure follow-up, Attendance Introduction Hypertensive disorders of pregnancy (HDP) represents one of the worldwide leading causes of maternal and perinatal mortality and a major cause of postpartum morbidity, mortality, and readmission [1–7], accounting for 6.9% of maternal deaths in the United States between 2011 and 2016, and with a high associated cost burden [6, 8−9]. HDP are a group of diseases, including gestational hypertension, preeclampsia, severe preeclampsia, chronic hypertension, chronic hypertension with superimposed preeclampsia, chronic hypertension with superimposed severe preeclampsia, eclampsia, or hemolysis elevated liver enzymes and low platelets (HELLP) syndrome [1–2]. Females that develop HDP are at a 2–4 fold increased risk for chronic hypertension after the pregnancy and a doubling of the risk of cardiovascular disease later in life [10–14]. Postpartum BP monitoring and follow-up after discharge is an essential component of pregnancy care for females with HDP, as most females with HDP are discharged 72 h after delivery [7]. The American College of Obstetricians and Gynecologists (ACOG) has previously recommended that females with HDP should be monitored for BP no later than 3–10 days after delivery and comprehensive postnatal visits and transition to women’s care should be provided 4–12 weeks postpartum, timing individualized and woman-centered [15]. In China, according to Chinese guidelines for the diagnosis and treatment of hypertension and preeclampsia in pregnancy [16, 17], BP should be closely monitored within 72 h after delivery, at least 4 to 6 times a day, and postpartum women with gestational hypertension should regularly monitor their BP and monitor it for at least 42 days. Moreover, all females with HDP should measure BP, and perform other exams, including urine routine, and lipid and glucose screening 3 months postpartum, which should also be followed up for life [16, 17]. Only 52.3–63.0% of the postpartum HDP patients attended a postpartum BP visit around 6 weeks postpartum [18–19], and 24.0–49.0% attended a visit around 12 weeks postpartum [19–20]. It is therefore prudent to identify who will be less likely to monitor BP, so that interventions to increase compliance may be attempted. Then, health care providers may have a better opportunity to early identify the disease and intervene before serious consequences occur. However, to date, the extent of adherence to postpartum BP follow-up and the influence factors in postpartum discharged HDP p (...truncated)