Introduction: Pregnancy-related hypertension (PRH) is a risk factor for cardiovascular disease (CV) later in life and is associated with chronic hypertension after delivery. The early post-partum period is important for identifying at-risk women who would benefit from CV screening and therapies. The transition from obstetrical to long-term continuity care may not be seamless due to lack of PRH awareness and competing demands for time. We hypothesized that women diagnosed with PRH have low rates of follow-up with outpatient providers within 180 days after delivery.
Methods: We used medical claims from a large national insurer from 2005 to 2013 to identify all pregnant women with PRH, as defined by diagnosis codes for gestational hypertension, preeclampsia, or eclampsia. We compared this cohort to two control cohorts: (1) pregnant women with chronic hypertension (CH) without PRH, and (2) pregnant women with neither CH nor PRH. Our primary outcome was any follow-up with outpatient providers within the 180 days following delivery.
Results: We identified 495,814 completed pregnancies (see Table). Among the PRH cohort, gestational hypertension was most common (70%), followed by mild (44%) and severe (23%) preeclampsia. Women with PRH and CH had higher rates of coexisting chronic conditions compared to non-hypertensive controls, including diabetes, lipid disorders, and coronary artery disease. Rates of follow-up with primary care or cardiology providers were 26% in PRH cohort, 30% in CH cohort, and 19% in controls. Follow-up was slightly better with OB providers: 35%, 33%, and 32%, respectively.
Conclusions: The peripartum period is an important opportunity to identify young women at higher risk for subsequent adverse CV events, yet the majority of women with either CH or PRH did not follow-up within 6 months after delivery. Low rates of outpatient follow-up may result in missed opportunities for CV risk reduction among these women, with subsequent higher CV incidence.