Emily Rosenfeld, during her fellowship in maternal-fetal medicine at Rutgers Robert Wood Johnson Medical School (RWJMS), observed a recurring issue of postpartum mothers returning to the hospital due to hypertension. This observation led her to pursue a study published in JACC: Advances, aiming to address this problem through close monitoring of blood pressure in postpartum mothers.
Rosenfeld explains that the study was motivated by the need to reduce costly and potentially life-threatening hospital revisits caused by hypertension. She notes, “During my maternal-fetal medicine fellowship, I noticed that a lot of patients were returning to the hospital for hypertension, which interrupts mother-infant bonding, impacts breastfeeding, adversely affects mental health and is expensive for the health care system.”
The study, titled “Management of Postpartum Preeclampsia and Hypertensive Disorders,” set out to determine if maintaining tighter control over blood pressure could lower emergency department visits among postpartum patients with hypertensive disorders. The target was set at less than 130/80 mmHg. According to Rosenfeld, “We showed a 68% decrease in emergency department visits for patients with tight blood pressure control.”
The study examined various conditions such as gestational hypertension, preeclampsia, and chronic hypertension. While no significant effect was noted based solely on diagnosis, it appeared those with chronic conditions might benefit more from this intervention.
Rosenfeld addressed existing guidelines that suggest medication only when blood pressure exceeds 150/100 mmHg postpartum. However, she points out that newer recommendations from the American Heart Association advocate for a lower threshold of 130/80 mmHg outside pregnancy contexts.
She suggests potential revisions to current guidelines if these findings are confirmed through further trials: “If this study is confirmed in a randomized clinical trial, we would urge the American College of Obstetricians and Gynecologists to revise their guidelines for treating hypertension in the postpartum period.”
This approach may have long-term benefits affecting up to 10% of pregnant women delivering in the U.S., emphasizing improved management strategies.
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