Postpartum healthcare utilization and morbidity among diabetic versus nondiabetic individuals in remote hypertension...

Individuals with diabetes (gestational or pregestational) are at increased risk of adverse outcomes, particularly in the setting of hypertension (HTN) in pregnancy. Though remote self-measured blood pressure (SMBP) monitoring programs may reduce rates of HTN-related hospital readmission, emergency department (ED) presentations, or severe maternal morbidity (SMM), it is unclear whether the extent of this reduction differs between those with and without diabetes. We aimed to compare outcomes between postpartum patients in our remote SMBP program with versus without diabetes.

Since November 2022, postpartum patients with HTN at our tertiary care hospital have been offered enrollment in our remote SMBP program, which involves a nurse practitioner remotely managing blood pressure for 6 weeks postpartum. For this analysis, participants were stratified by the presence of pregestational or gestational diabetes. Participants with unknown diabetes status were excluded. The primary outcome was a composite of postpartum readmission or ED presentation for HTN within 30 days of delivery hospitalization. Secondary outcomes included HTN-related SMM and remote medication initiation. A generalized linear model was used to estimate relative risks (RRs) after adjustment for differences in demographic, obstetric, and medical conditions.

Among the first 2000 participants in the SMBP program, 17% had diabetes. Compared to those without diabetes, those with diabetes were older, less likely to identify as White, or have gestational hypertension. They were more likely to have chronic hypertension, be delivered via cesarean, and have a lower median gestational age at delivery. After adjusting for these factors, there was no difference in the risk of the composite outcome of HTN-related postpartum readmission or ED presentation between those with and without diabetes (15.92% vs. 16.56%; adjusted RR, 0.92 [0.70, 1.21]). Similarly, there were no differences in secondary outcomes.

In our remote SMBP program for postpartum patients with HTN, unplanned HTN-related healthcare utilization or SMM was similar between those with and without diabetes. While this study may have been underpowered to detect small differences, these findings suggest that at a minimum, the current monitoring strategy meets the standard of care for patients with HTN and diabetes.