Nearly 20% of postpartum patients in America develop high blood pressure; Epic Research just found in a new study that postpartum hypertension nearly triples the chances of rehospitalization.

After looking at more than 1.2 million birth encounters and then grouping and comparing the highest blood pressure readings taken in the 24 hours after discharge, the study found:

Patients with blood pressure levels at or above 160/110 shortly before discharge are nearly three times more likely to be readmitted than patients with normal blood pressure readings.
More than 5% of postpartum patients with the highest blood pressure readings, equal to or greater than 160/110 mmHg, were readmitted.
This data suggests a close relationship between postpartum blood pressure control and readmission in the postpartum period.

Dr. Christopher Alban is a physician and clinical informaticist at EHR vendor Epic in Verona, Wisconsin. He is the lead author of the study. Dr. Kelly Gibson is division director of maternal fetal medicine at MetroHealth in Cleveland, Ohio.

Healthcare IT News sat down with the two of them to discuss the study and the role healthcare information technology can play in helping solve the problem.

Q. Please talk about the results of your study on postpartum hypertension and rehospitalization.

Gibson: Pre-eclampsia and other hypertensive disorders of pregnancy are common and one of the leading causes of maternal morbidity and mortality. While the majority of the attention for detection and timely treatment of this disorder focuses on the period before and during delivery, a significant proportion of cases occur after birth in the postpartum period.

In the week after delivery, approximately half of patients will have persistence of elevated blood pressures and 2-5% will be readmitted for further treatment.

However, the relationship between postpartum blood pressure control and readmission is unclear. Because this complication, while one of the leading causes of postpartum readmissions, is relatively rare, we needed a large dataset to perform this study.

“The findings suggest that by treating blood pressures to a lower target, some readmissions can be prevented.”

Dr. Kelly Gibson, MetroHealth

Having a large group of patient data gives us enough statistical power to look at rare outcomes and make recommendations. The Epic Cosmos dataset contains millions of linked records between the birth parent and babies, making it a rich resource for obstetric studies.

In our study we found that postpartum patients with lower blood pressures at discharge have a lower readmission rate than patients discharged with elevated blood pressures. This suggests that improved blood pressure control after delivery may reduce the rate of readmissions and maternal morbidity in the postpartum period. Further prospective studies are needed to determine the best course and duration of treatment.

Q. You suggest that postpartum care should continue after birth. Why, based on your findings, do you believe this?

Gibson: The physiologic changes of pregnancy occur over the nine months of gestation, and they do not immediately end with delivery of the baby and the placenta. These changes in a pregnant patient’s body, as well as the physical and emotional toll of childbirth, last for months following birth.

One of these changes is the impact on the cardiovascular system and blood pressure. For 5-10% of patients, their blood pressure will rise during pregnancy from either gestational hypertension or pre-eclampsia.

We know that having pre-eclampsia increases a patient’s short-term risk of readmission as well as the long-term risk of cardiovascular disease. Therefore, treatment and follow up for these patients is essential to promote the long-term health of new parents.

When I began training, I would tell patients that “delivery is the treatment for pre-eclampsia,” and there was little focus on the blood pressures after hospital discharge. We now understand that delivery is part of the treatment for the disease, but the disease lingers. Appropriate monitoring and treatment can lower a patient’s risk of readmission, morbidity and even mortality after delivery.

Current recommendations are for blood pressure checks after discharge and education with “Post-Birth Warning Signs” for patients. What the goal blood pressure should be or whether blood pressure values in the hospital are related to short-term and long-term outcomes is not clear.

Our hypothesis was that higher blood pressures in the hospital translated into higher values at home and an increased risk for readmission and morbidity. With this study we were able to show a strong correlation between blood pressure and readmission and we are now using this to advise for tighter control of maternal blood pressures prior to discharge.

Q. How can monitoring blood pressure levels for patients after childbirth lessen the chance of the patient being readmitted to the hospital?

Gibson: One of the most common reasons for readmission after delivery is elevated blood pressures. These readmissions are essential for the health of the postpartum patient, but they can be very disruptive to the new family at home. Readmissions can lead to short-term separation between parent and baby, impact the success of breastfeeding, and cause increased stress and anxiety.

Our study showed a relationship between elevated blood pressures and readmission. The findings suggest that by treating blood pressures to a lower target, some readmissions can be prevented.

We can use this data to support further research on the best treatment regimen and goal blood pressures. With improved blood pressure control, obstetric care providers can help to improve maternal outcomes, keeping new parents healthier and at home with their newborns.

Q. What is the role of healthcare information technology in all of this?

Alban: As Kelly mentioned earlier, identifying the patterns around an infrequently occurring clinical condition can be challenging without a large clinical dataset. This is where Cosmos, Epic’s massive EHR data analysis platform, comes into play.

As the number of organizations using Epic rose over the past few years, it became clear that we had an opportunity to create a new, health research-focused database that would be unlike any other in existence.

Cosmos combines billions of clinical data points in a way that forms a high-quality, representative, deduplicated and integrated data set that can be used to change the health and lives of people everywhere.

As of January 2023, Cosmos contains records from 190 organizations, including 176 million patients and 6.3 billion encounters. Critical to this study was the ability to link data between newborn babies and their birth parents.

Since Epic Research’s first published briefs early in the COVID-19 pandemic, we’ve been investigating clinical questions to help expedite decisions about medications and therapeutic options.

And perhaps most important, the Cosmos database is available to all participating organizations. This study was a great example of a collaborative approach between Kelly, an obstetrician at MetroHealth, and me, a physician researcher at Epic.

This collaborative approach has also been used by Epic Research with the U.S. Food and Drug Administration, the U.S. Department of Health and Human Services, the CDC, and the Kaiser Family Foundation, among others, and we continue to look for opportunities to collaborate with our Cosmos-participating organizations in the future.

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Email the writer: bsiwicki@himss.org
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