Tallmadge Maggie, Livergood Mary Christine, Tvina Alina, Evans Sarah, McIntosh Jennifer, Palatnik Anna
Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin.
Am J Perinatol. 2023 Oct;40(14):1579-1584. doi: 10.1055/s-0041-1739291. Epub 2021 Nov 14.
This study aimed to assess maternal characteristics that predict attendance of postpartum blood pressure evaluation in patients with hypertensive disorders of pregnancy (HDP).
A retrospective case-control study of patients with HDP delivering at a single academic institution (2014-2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of the 7- to 10-day postpartum blood pressure evaluation.
Of the 1,041 patients included in the analysis, 603 (57.9%) attended the 7- to 10-day postpartum blood pressure check. Maternal sociodemographic, clinical, and obstetric factors differed significantly between patients who attended the postpartum blood pressure visit and those who did not. In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild-range blood pressures on day of discharge, and initiation of antihypertensive medication were associated with attendance of the 7- to 10-day postpartum visit. In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (adjusted odds ratio [aOR]: 1.58; 95% confidence interval: [CI]: 1.14-2.17), severe HDP (aOR: 1.94, 95% CI: 1.44-2.61), and cesarean birth (aOR: 1.92, 95% CI: 1.43-2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR: 0.68, 95% CI: 0.47-0.97), and public insurance (aOR: 0.65, 95% CI: 0.45-0.93) compared with private insurance.
Clinical factors such as nulliparity, severe HDP, and cesarean birth were associated with higher rates of postpartum blood pressure evaluation attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance.
· A total of 57.9% of patients with HDP attended in person postpartum blood pressure check.. · Nulliparity, severe features of HDP, and cesarean birth were associated with higher rates of attendance.. · Non-Hispanic black race and ethnicity and public insurance were associated with lower attendance..
本研究旨在评估妊娠高血压疾病（HDP）患者中预测产后血压评估就诊情况的母体特征。
对在单一学术机构分娩的HDP患者进行回顾性病例对照研究（2014 - 2018年）。HDP的诊断包括妊娠期高血压、慢性高血压、先兆子痫和子痫前期合并症。采用单变量和多变量分析来确定与产后7至10天血压评估就诊情况独立相关的母体特征。
纳入分析的1041例患者中，603例（57.9%）进行了产后7至10天的血压检查。进行产后血压检查的患者与未进行检查的患者在母体社会人口统计学、临床和产科因素方面存在显著差异。在单变量分析中，初产妇、非西班牙裔黑人种族和族裔、公共保险、伴有严重特征的HDP、剖宫产、分娩时的孕周、接受镁剂治疗、出院当天血压处于轻度范围以及开始使用降压药物与产后7至10天的就诊情况相关。在多变量分析中，与更高就诊几率显著相关的因素为初产妇（调整优势比[aOR]：1.58；95%置信区间[CI]：1.14 - 2.17）、严重HDP（aOR：1.94，95% CI：1.44 - 2.61）和剖宫产（aOR：1.92，95% CI：1.43 - 2.59）。相比之下，与较低就诊几率相关的因素为非西班牙裔黑人种族和族裔与非西班牙裔白人相比（aOR：0.68，95% CI：0.47 - 0.97），以及公共保险与私人保险相比（aOR：0.65，95% CI：0.45 - 0.93）。
初产妇、严重HDP和剖宫产等临床因素与产后血压评估的较高就诊率相关，而母体非西班牙裔黑人种族和族裔以及公共保险等社会人口统计学因素与产后血压检查的较低就诊几率相关。
· 共有57.9%的HDP患者亲自进行了产后血压检查。· 初产妇、HDP的严重特征和剖宫产与较高的就诊率相关。· 非西班牙裔黑人种族和族裔以及公共保险与较低的就诊率相关。
