Findings from a Rutgers Health study could help improve mother-infant bonding, successful breastfeeding and mental health
When Emily Rosenfeld was doing a fellowship in maternal-fetal medicine at Rutgers Robert Wood Johnson Medical School (RWJMS), she noticed that many patients were returning to the hospital for hypertension.
In a new Rutgers Health study published in JACC: Advances, Rosenfeld, who now teaches at RWJMS and practices at Robert Wood Johnson University Hospital, pursues a novel approach to solve the problem: implement a plan for very close monitoring of the blood pressure of mothers postpartum, as a means of decreasing hospital revisits that are costly for the health care system and potentially life threatening for patients.
Rosenfeld discusses the origins of the study and the outcomes.
How did your experience prompt you to study what you were seeing clinically more in depth?
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. In addition, several remote patient monitoring studies have shown an increase in emergency department visits.
In our study, we sought to implement a novel approach with tighter blood pressure control in the postpartum period to try to decrease hospital revisits that could lead to maternal morbidity and mortality.
What were the goals for the study?
The Management of Postpartum Preeclampsia and Hypertensive Disorders study aimed to assess the effect of treatment or tight blood pressure control for a lower blood pressure threshold - less than 130 (systolic pressure) over 80 (diastolic pressure) millimeters of mercury (mmHg) - on reducing emergency department visits in postpartum patients with hypertensive disorders.
It also aimed to study both systolic and diastolic blood pressure at six weeks postpartum; numbers of hospital readmissions for hypertensive disorders; and attendance at postpartum office visits.
We showed a 68% decrease in emergency department visits for patients with tight blood pressure control, and throughout the six weeks of follow-up, blood pressure improved. In addition, there was a trend toward decreasing hospital readmission for hypertension (91% decrease) and a trend toward an increase in postpartum office visits (37% increase).
What are the conditions that benefit the most from treatment?
In this study, we looked at all patients with hypertensive disorders, including gestational hypertension, preeclampsia and chronic hypertension. While we were not able to show an effect by diagnosis alone, it does appear that those who are sicker, with chronic hypertension or preeclampsia, may benefit the most from the intervention.
What are the current blood pressure guidelines and how did you address them?
In 1987, a small study published in The Lancet suggested that we only use medication to treat postpartum patients with blood pressure above 150/100 mmHg. The current American College of Obstetrics and Gynecology guidelines for managing postpartum hypertension cite manuscripts that lead back to this original Lancet paper as the reason to only to give medication if blood pressure is above 150/100 mmHg in the postpartum period.
However, the American Heart Association recommends a goal blood pressure below 130/80 mmHg as an indicator of heart health outside of pregnancy. Given that we have an unacceptably high rate of maternal morbidity and mortality in the United States, we questioned if using newer guidelines could change outcomes.
Our study did show that treatment using a cutoff of 130/80 mmHg was safe and that it decreased emergency department visits for hypertension. It also showed that there were improved blood pressures throughout the six weeks postpartum.
How can your results be used to improve outcomes for more patients?
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 and to lower the blood pressure threshold to 130/80 mmHg.
This improved management strategy may have long-term health benefits that could impact up to 10% of pregnant women delivering in the United States today.
Explore more of the ways Rutgers research is shaping the future.
