Incidence of postpartum hypertension among Kenyan women with preeclampsia: a prospective cohort study
Background: The burden of cardiovascular disease (CVD) is rising in sub-Saharan Africa (SSA). Preeclampsia, a type of hypertensive disorder of pregnancy, is a unique risk factor for CVD among women, yet little is known about the postpartum cardiovascular risk among women with preeclampsia in SSA. Objective: To determine the incidence of hypertension, a major risk factor for CVD, at 6-months postpartum among Kenyan women with preeclampsia. Methods: This prospective cohort study included all pregnant or recently postpartum women with preeclampsia who were admitted to a national, referral hospital in western Kenya from January 20, 2020-March 19, 2020, when the study was unexpectedly paused due to the COVID-19 pandemic. Using home blood pressure monitoring technique, we described the trajectory of blood pressure after delivery. Bivariate and multivariable regression analyses were performed to investigate for risk factors associated with hypertension at 6-month follow-up. Results: Eight-six women with preeclampsia were enrolled prior to March 19, 2020, when the study was unexpected paused due to the COVID-19 pandemic. Among the 50 women who completed follow up, 38% (n=19) had hypertension. Blood pressure normalized for all women by 6 weeks after delivery but rose again beyond 12 weeks among those with hypertension at follow up. Maternal age, parity and history of preeclampsia in prior pregnancy or a previous pregnancy complication (preterm delivery or stillbirth) were associated with hypertension at follow up. Overall, rates of routine, postpartum clinic follow up were low (64%) among women despite nearly all (97%) attending clinic for infant immunizations following delivery. Conclusion: There is a high incidence of hypertension at 6-months postpartum among Kenyan women with preeclampsia, though low rates of postpartum follow up care indicate a potential missed opportunity for early CVD identification and prevention among this high risk-population.
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