Hypertensive Postpartum Admissions Among Women Without a History of Hypertension or Preeclampsia

OBJECTIVE: To analyze risk factors, temporality, and outcomes for women readmitted postpartum for a hypertensive indication who did not have a hypertensive diagnosis during their delivery hospitalization. METHODS: The Healthcare Cost and Utilization Project's Nationwide Readmissions Database for 2010-2014 was used to evaluate risk for postpartum readmission for preeclampsia and hypertension within 60 days of discharge from a delivery hospitalization among women without these diagnoses during delivery in this cohort study. Obstetric, medical, demographic, and hospital factors associated with postpartum readmission were analyzed. Both unadjusted and adjusted analyses were performed. Risk was characterized as unadjusted and adjusted risk ratio with 95% CI. As a secondary outcome, risk for severe maternal morbidity during readmissions was also evaluated comparing women with and without hypertensive diagnoses during their delivery hospitalization. RESULTS: Among delivery hospitalizations without a hypertensive diagnosis at delivery, absolute rates of readmission within 60 days for a hypertensive indication were low, with one readmission occurring per 687 deliveries for all women. The rate rose to 1 in 498 among women 35-39 years of age, 1 in 337 for women 40-54, 1 in 601 for women with Medicaid, 1 in 506 for women with Medicare, 1 in 497 with cesarean delivery, 1 in 600 with postpartum hemorrhage, 1 in 455 and 1 in 378 for gestational and pregestational diabetes, respectively, 1 in 428 for asthma, 1 in 225 for chronic kidney disease, and 1 in 214 for lupus. For the secondary outcome, risk for severe maternal morbidity was higher for women without a hypertensive indication during their delivery compared with women with a diagnosis (12.1% vs 6.9%, P<.01). CONCLUSION: Risk for hypertensive postpartum readmissions for women without delivery-hospitalization preeclampsia or hypertension is low. Future comparative effectiveness and clinical research is indicated to determine whether earlier postpartum identification of elevated blood pressure followed by increased surveillance and counseling may further reduce risk.