Impact of Blood Pressure Levels During Pregnancy on Postpartum Hypertensive Outcomes: Insights from a Cohort Study

Background/Objectives: This cohort study aims to evaluate the association between antenatal blood pressure levels and postpartum cardiovascular outcomes in women with preeclampsia and/or fetal growth restriction (FGR). The objective of the study was to test the hypothesis that blood pressure levels during pregnancy are associated with cardiovascular health after delivery. Methods: The study was conducted at a tertiary hospital in Germany and involved women who developed preeclampsia and/or FGR during their pregnancies between 2021 and 2024. Participants were invited for cardiovascular follow-up consultations at 6 weeks and 6 months postpartum. VICORDER measurements were used for cardiovascular function assessment. Results were compared between the group with persisting hypertension and normotensive women at each study visit to assess the long-term progression of hypertensive disorders in relation to antenatal blood pressure levels. Statistical analysis employed Mann-Whitney U tests and adjusted odds ratios (aORs). Results: Of the 103 women who attended postpartum cardiovascular consultations during the study period, a substantial proportion still had elevated blood pressure at 6 weeks (51.49%) and 6 months (42.86%) after delivery. Women with persistent hypertension had higher systolic and diastolic blood pressure throughout pregnancy (p < 0.001), used antihypertensive medication more frequently (p < 0.001) and showed significantly increased arterial stiffness up to 6 weeks postpartum compared with normotensive women (7.4 m/s vs. 6.7 m/s, p < 0.001). In adjusted analyses, higher blood pressure levels during pregnancy were significant predictors of persistent postpartum hypertension (p < 0.05). Except for systolic blood pressure in the 3rd trimester at the 6-week follow-up, every 10 mmHg increase in blood pressure during pregnancy was associated with higher odds of postpartum hypertension, with aORs ranging from 1.82 to 3.42 at 6 weeks and from 2.18 to 5.51 at 6 months postpartum (depending on the trimester). Conclusions: Maintaining healthy blood pressure levels during pregnancy may reduce the long-term cardiovascular risk for mothers. These findings underscore the importance of early detection and consistent management of hypertension in expectant mothers with hypertensive pregnancy disorders. Further research is required to identify optimal blood pressure management strategies during pregnancy that could improve immediate and long-term maternal health outcomes.