Postpartum course of gestational hypertension and preeclampsia

New onset hypertension (gestational hypertension and preeclampsia) complicates 6-8% of pregnancies and usually resolves postpartum, but the time to normalization of blood pressure (BP) in the postpartum period is not known.

We performed a retrospective cohort study of previously normotensive women who developed gestational hypertension or preeclampsia, and determined the number of weeks postpartum to BP normalization.

62 women with no history of hypertension prior to pregnancy were included, age 35.3 +/- 7.1 years. Hypertension developed at gestational age 15-40 weeks; 45% developed hypertension within 3 days of delivery, 52% developed hypertension 1-22 weeks prior to delivery, and 5% had onset only postpartum. Infants were born at gestational age 35.15 +/- 4.7 weeks. Average BP at treatment initiation was 162/95 mm Hg. Preeclampsia and/or HELLP syndrome was diagnosed in 48%. Most were treated with BP medication in the puerperium. In those whose BP normalized, time to normalization was 5.4 +/- 3.7 weeks. Those who remained hypertensive beyond 6 months (19%) were older (38.8 years vs. 34.4, p = 0.018). Three women had secondary hypertension; primary hyperaldosteronism was diagnosed in 2 women and renovascular hypertension in 1.

Hypertension presenting in pregnancy normalized postpartum in 81% of this cohort, in most by 3 months. Those who remained hypertensive at 6 months postpartum tended to be older than patients whose BP normalized. Secondary hypertension was detected and surgically corrected in 3 patients. Further studies are needed to characterize those most likely to benefit from postpartum antihypertensive treatment and to guide management.