Postpartum counseling in women with hypertensive disorders of pregnancy

2020 
Abstract: Background Hypertensive disorders of pregnancy (HDP) are associated with increased cardiovascular disease (CVD) risk across the lifespan. The American College of Obstetricians and Gynecologists and the American Heart Association emphasize the postpartum period as an important opportunity to identify and intervene upon women at high-risk for future CVD. Objective To determine the proportion of women with documented counseling on risks and transitions of care after HDP at the postpartum visit. Study Design Retrospective longitudinal descriptive study of women with HDP enrolled in a text-based blood pressure program from 9/2018-02/2019. We abstracted counseling in the discharge summary and postpartum note from the electronic medical record. The primary outcome was counseling at the postpartum visit defined as documentation of 1) follow-up with primary care or cardiology, 2) risk of CVD, or 3) recommendation for aspirin in a future pregnancy. We assessed demographic and clinical factors that may influence counseling through multivariable logistic regression. We also compared the proportion of women counseled on HDP versus contraception and glucose tolerance tests at the postpartum visit. Results Of 320 eligible women, the majority of women had gestational hypertension or preeclampsia without severe features (64%). Postpartum visits were scheduled in our hospital system for 284 women of which 253 attended (89%). Documented counseling occurred for 62 women (25%). Counseling on follow-up with primary care or cardiology, CVD risk, and aspirin in future pregnancies were documented for 51 (20%), 15 (6%), and 1 (0.4%), respectively. Only 1 woman had documented counseling on all three components. In multivariable analysis, Black race remained an independent factor that increased the likelihood of counseling on HDP (aOR 2.77, 95% CI 1.32-5.83). Women were significantly less likely to be counseled on HDP than on contraceptives (99%, p Conclusions Postpartum counseling on HDP merits urgent improvement efforts amongst obstetric care providers.
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