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Postpartum Hypertension and the Role of Postpartum Clinics and Digital Health

Authors
  • Harrington, Colleen M.1
  • Sorour, Nouran1
  • Troy, Stephen2
  • Botros, Mina2
  • Ciuffo, Marissa1
  • Sardella, Nicole1
  • Wilkie, Gianna2
  • Aurigemma, Gerard P.1
  • Kovell, Lara C.1
  • 1 University of Massachusetts Medical School, 55 Lake Avenue North, S3-860, Worcester, MA, USA , Worcester (United States)
  • 2 University of Massachusetts Medical School, Worcester, MA, USA , Worcester (United States)
Type
Published Article
Journal
Current Treatment Options in Cardiovascular Medicine
Publisher
Springer US
Publication Date
Jul 21, 2021
Volume
23
Issue
9
Identifiers
DOI: 10.1007/s11936-021-00937-y
Source
Springer Nature
Keywords
Disciplines
  • Topical Collection on Reproductive Health and Cardiovascular Disease
License
Yellow

Abstract

Purpose of reviewPostpartum hypertension is common, vastly underrecognized and increases the risk for future cardiovascular events. One of the most common risk factors for the development of postpartum hypertension is preexistent hypertensive disorders of pregnancy (HDP). According to Cirillo and Cohn (2015), HDP complicate 5–10% of pregnancies worldwide, and their prevalence is increasing. Unfortunately, many clinicians and patients are not aware of the risks associated with HDP, nor are they aware of the importance of monitoring blood pressure in the postpartum period. Telemedicine and digital health may improve the detection and treatment of postpartum hypertension.Recent findingsDuring the first year after delivery, women with HDP have a 12- to 25-fold greater risk of developing chronic hypertension (HTN), which is the most common cause for readmission. In addition to HDP, there are also secondary causes of HTN that need to be considered in the appropriate setting such as medications and endocrine and renal disorders. There is little data regarding the effectiveness of antihypertensive medications and the role of diet and exercise in the management of postpartum HTN. Early postpartum healthcare follow-up is associated with better maternal and fetal outcomes, as discussed by Goulet et al. (2007). Yet, McKinney et al. (2018) estimated that only 40% of women attend face-to-face follow-up with a healthcare provider 6 weeks after delivery. This emphasizes the need for innovative models to improve rates of follow-up and better accessibility of healthcare monitoring and intervention for postpartum women.SummaryScreening for postpartum HTN is essential. The establishment of structured follow-up incorporating postpartum clinics, whether remote or in-person, would allow monitoring of blood pressure, increasing the detection and treatment of postpartum HTN and improving its management and treatment. These visits also provide an opportunity for providers to assess and educate women about other modifiable cardiovascular risk factors with the goal of reducing their overall cardiovascular risk profile and likelihood of future cardiac events. Digital health resources and interventions are becoming readily available and more popular among mothers when compared to in-person follow-up. This is likely due to lower burden of transportation, less cost, and availability of online support. Finally, further clinical studies investigating antihypertensive medications and the effect of diet and exercise on postpartum hypertension are critical.

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