Demographic and Clinical Predictors of Postpartum Blood Pressure Screening Attendance Open Access

Abstract

Hypertensive disorders of pregnancy (HDP) are a leading cause of preventable maternal and neonatal morbidity and mortality. Postpartum hypertension that develops after women leave the hospital is particularly dangerous, as it can go undiagnosed and cause complications. The American College of Obstetricians and Gynecologists recommends women with HDP have a blood pressure (BP) check one week after delivery to detect postpartum hypertension. Yet, little is known about attendance at the BP check visit or the clinical and demographic predictors of attendance. The goal of this study was to describe the demographic and clinical predictors of postpartum BP screening attendance among a high-risk, safety-net population in the Southeast.

We conducted a population-based cohort study of pregnant women who delivered at a large public hospital in Atlanta between July 1, 2016 and June 30, 2018. We manually abstracted data on demographic and clinical characteristics of participants, yielding 1,360 women with HDP. Among this sample of mostly non-Hispanic black, publicly insured women, 23.8% attended a BP check within three weeks postpartum. In a multivariable log binomial regression model, severe HDP (aRR 2.29, 95% CI 1.57-3.33) and Cesarean delivery (aRR 1.61, 95% CI 1.21-2.15) were positive predictors of BP check attendance. Negative predictors included low PNC utilization (aRR 0.32, 95% CI 0.20-0.50), non-Hispanic black race/ethnicity (aRR 0.50, 95% CI 0.28-0.88), higher parity (aRR 0.63, 95% CI 0.43-0.93), and public insurance (aRR 0.68, 95% CI 0.39-1.15).

Among a high-risk, safety-net population with HDP in the Southeast, most women are not getting their BP screened within three weeks postpartum. Addressing this gap will require additional research and creative solutions to address barriers at the individual-, provider-, and system-levels.

Table of Contents

Table of Contents

Introduction ................................................................................................................................... 1

Problem Statement ...................................................................................................................... 4

Purpose Statement ....................................................................................................................... 5

Significance Statement ................................................................................................................ 6

Definition of Terms ..................................................................................................................... 7

Literature Review ....................................................................................................................... 10

Postpartum Blood Pressure Screening Rates ............................................................................ 11

Predictors of Postpartum Visit Attendance ............................................................................... 15

Diabetes Postpartum Screening ................................................................................................. 38

Summary of current problem and study relevance.................................................................... 42

Methodology ................................................................................................................................ 44

Population and Sample .............................................................................................................. 44

Research Design ........................................................................................................................ 45

Procedures ................................................................................................................................. 45

Instruments ................................................................................................................................ 46

Plans for Data Analysis ............................................................................................................. 47

Ethical Considerations............................................................................................................... 51

Results .......................................................................................................................................... 52

Sample Characteristics .............................................................................................................. 52

Bivariable Analysis ................................................................................................................... 52

Multivariable Analysis .............................................................................................................. 55

Sensitivity Analysis ................................................................................................................... 57

Discussion..................................................................................................................................... 59

Limitations and Strengths.......................................................................................................... 61

Conclusion ................................................................................................................................. 63

References .................................................................................................................................... 65

Tables and Figures ...................................................................................................................... 69

Table 1. ...................................................................................................................................... 69

Table 2. ...................................................................................................................................... 77

Table 3. ...................................................................................................................................... 79

Table 4. ...................................................................................................................................... 80

Table 5. ...................................................................................................................................... 80

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Obstetrics and Gynecology
Keyword	Postpartum HDP Hypertension
Committee Chair / Thesis Advisor	Sheree Boulet, Emory University
Committee Members	Roger Rochat, Emory University

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