Journal article
Identification of Distinct Risk Factors for Antepartum and Postpartum Preeclampsia in a High-Risk Safety-Net Hospital
American journal of perinatology, Vol.41(S 01), pp.e267-e274
07/10/2022
DOI: 10.1055/a-1878-0149
PMID: 35709733
Abstract
Abstract
Objective
Postpartum preeclampsia (PE), defined as de novo PE that develops at least 48 hours following delivery, can be particularly dangerous as many patients are already discharged at that point. The goal of our study was to identify risk factors uniquely associated with the development of late postpartum preeclampsia (PPPE).
Study Design
In a retrospective cohort study of deliveries between July 1, 2016 and June 30, 2018 at a safety-net hospital in Atlanta, Georgia, we used multinomial logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between demographic, medical, and obstetric factors and development of PE, categorized as a three-level outcome: no PE, antepartum/intrapartum preeclampsia (APE) (diagnosed prior to or < 48 hours of delivery), and late PPPE (diagnosed ≥ 48-hour postpartum).
Results
Among 3,681 deliveries, women were primarily of ages 20 to 35 years (76.4%), identified as non-Hispanic Black (68.5%), and covered by public health insurance (88.6%). PE was diagnosed prior to delivery or within 48-hour postpartum in 12% (
n
= 477) of the study population, and 1.5% (57) developed PE greater than 48-hour postpartum. In the adjusted models, maternal age ≥ 35, race/ethnicity, nulliparity, a diagnosis of pregestational or gestational diabetes, and chronic hypertension were associated with increased odds of APE only, while maternal obesity (OR: 1.9; 95% CI: 1.0–3.5) and gestational hypertension (OR: 2.7; 95% CI: 1.5–4.8) were uniquely associated with PPPE. Multifetal gestations and cesarean delivery predicted both PPPE and APE; however, the association was stronger for PPPE.
Conclusion
Patients with obesity, gestational hypertension, multifetal gestations, or cesarean delivery may benefit from additional follow-up in the early postpartum period to detect PPPE.
Key Points
Late postpartum preeclampsia may go undetected, particularly in low-income patients.
In a delivery cohort in Georgia, 1.5% of patients developed late postpartum preeclampsia.
Maternal obesity and gestational hypertension were strongly associated only with late postpartum preeclampsia.
Details
- Title: Subtitle
- Identification of Distinct Risk Factors for Antepartum and Postpartum Preeclampsia in a High-Risk Safety-Net Hospital
- Creators
- Michelle Picon - Emory UniversityKaitlyn K. Stanhope - Emory UniversityDenise J. Jamieson - Emory UniversitySheree L. Boulet - Emory University
- Resource Type
- Journal article
- Publication Details
- American journal of perinatology, Vol.41(S 01), pp.e267-e274
- Publisher
- Thieme Medical Publishers, Inc
- DOI
- 10.1055/a-1878-0149
- PMID
- 35709733
- ISSN
- 0735-1631
- eISSN
- 1098-8785
- Language
- English
- Electronic publication date
- 07/10/2022
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446415002771
Metrics
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