Incidence and Risk Factors of De Novo Postpartum Hypertension: Understanding Links to Long-Term Cardiovascular Risk

Individuals developing hypertensive disorders of pregnancy face a 2- to 5-fold risk of long-term cardiovascular disease. Limited data exist on de novo postpartum hypertension (dnPPHTN), where those normotensive during pregnancy develop hypertension immediately postpartum. Under-recognition of dnPPHTN can lead to severe morbidity due to delayed or absent treatment and missed opportunities for mitigating long-term cardiovascular disease risk.

The aim of the study was to estimate the incidence of dnPPHTN and identify demographic and clinical risk factors for its development.

This retrospective cohort study analyzed 506 postpartum individuals delivering at a tertiary care institution over 1 month. Participants were classified as: 1) normotensive; or 2) dnPPHTN, defined as systolic blood pressure (BP) ≥140 mm Hg and/or diastolic BP ≥90 mm Hg on at least 2 occasions up to 6 weeks postpartum after a normotensive pregnancy. We excluded those with prepregnancy or antepartum hypertensive disorders. Demographic and clinical characteristics were compared using adjusted logistic regression models.

Of 389 included participants, 35 (9.0%) developed dnPPHTN. Of these, 5.7% had pregestational diabetes compared to 0.6% of normotensive individuals (P = 0.042; adjusted OR: 11.3; 95% CI: 1.8-73.1). Early prenatal diastolic BP was higher in the dnPPHTN group (72.2 vs 68.4 mm Hg, P = 0.008), though this difference did not persist after adjustment. Medication-dependent gestational diabetes mellitus (ie, A2GDM) was associated with dnPPHTN (adjusted OR: 6.1; 95% CI: 1.2-30.1).

Pregestational diabetes and A2GDM are associated with dnPPHTN. Closer follow-up for BP monitoring postpartum and more urgent transitions of care for ongoing medical management may reduce long-term cardiovascular risk.