Integrating Maternal BP Checks in Pediatric Visits Enhances Outcomes

A recent study published in JAMA Network Open explores the potential benefits of integrating maternal blood pressure (BP) and preeclampsia symptom screening into well-child visits to improve the early detection and management of postpartum hypertensive disorders (HDP). The results demonstrated a significant increase in the detection and management of HDP following implementation of a quality improvement (QI) program.¹

Researchers conducted a pre-post QI study comparing eligible individuals who attended well-child visits before (December 2017 to December 2018) and after (March 2019 to December 2019) implementation of the QI program. This approach aims to address the increasing rates of postpartum morbidity and mortality associated with HDP by leveraging routine pediatric appointments as a dual opportunity for monitoring both child and maternal health.

The QI program consisted of 595 mothers preintervention and 565 mothers post intervention, with a mean (SD) age of 27.2 (6.1) years in the preintervention cohort and 27.0 (5.8) years in the postintervention cohort. Baseline demographic characteristics such as age, race and ethnicity, body mass index, and factors associated with increased risk for preeclampsia were not significantly different between the 2 groups. Participants included birth mothers who delivered at the researcher’s tertiary academic medical center and brought their newborns for well-child checks at 2 days, 2 weeks, and 2 months postpartum.

A standardized BP evaluation and referral process was followed, which was found to significantly improve the readmission rates for HDP. The readmission rate for postpartum preeclampsia rose from 2.1% (13 individuals) in the preintervention cohort to 5.6% (29 individuals) in the postintervention cohort (P = .007). In the postintervention cohort, 88% (29 of 33) of the obstetrics emergency department (OB-ED) visits recommended by the QI program resulted in readmissions due to postpartum preeclampsia. Additionally, readmissions occurred earlier in the postintervention group, at a median of 7 days postpartum compared with 10 days in the preintervention group (P = .001). The study authors concluded that "this QI program allowed for increased and earlier readmission due to postpartum preeclampsia."

In this study, outcomes were compared between 595 mothers in a preintervention group and 565 mothers in a postintervention group; readmission rates for postpartum hypertensive disorders significantly improved among those referred for postpartum preeclampsia | Image Credit: Prostock-studio-stock.adobe.com

Forty-two patients were readmitted due to postpartum preeclampsia, with no significant difference in the BP parameters found between the 2 groups at the time of presentation to the OB-ED. Intravenous antihypertensives were required in 59% of mothers in the postintervention group compared with 46% of mothers in the preintervention group, while oral antihypertensives were required for 83% and 62%, respectively. Half of the cases admitted were diagnosed as de novo postpartum preeclampsia. De novo postpartum preeclampsia was noted to be more likely present in the preintervention cohort (77% vs 38%; P < .001).

The study also revealed that 69% of the patients in the preintervention cohort were symptomatic at presentation vs 59% in the postintervention cohort (P = .75). The primary symptoms reported among symptomatic patients were headache (55%) and shortness of breath (7%).

Individuals readmitted for postpartum preeclampsia were more likely to be African American and to have an underlying HDP diagnosis prior to delivery admission discharge. This is consistent with previous study findings.²

"Maternal evaluation at the time of well-child visits presents a novel opportunity for maternal BP check and preeclampsia symptoms assessment," the authors concluded, acknowledging the need for further studies to verify and expand the applicability of this approach.

References

1. Amro FH, Smith KC, Hashmi SS, et al. Well-child visits for early detection and management of maternal postpartum hypertensive disorders. JAMA Netw Open. 2024;7(6). Published June 3, 2024. doi:10.1001/jamanetworkopen.2024.16844

2. Chornock R, Iqbal SN, Kawakita T. Racial disparity in postpartum readmission due to hypertension among women with pregnancy-associated hypertension. Am J Perinatol. 2021;38(12):1297-1302. doi:10.1055/s-0040-1712530