Never let your guard down. And most importantly, don’t be in a hurry to stop checking blood pressure values in the woman who has given birth. Because the classic postpartum hypertension, which occurs in women who had never had blood pressure problems before pregnancy, is misleading. And it doesn’t always show up at the moment of birth or a few days later, but it can also arrive weeks later, when the checks on the mother have become rarefied.
To warn is a research on just under 2500 women published on Hypertension and conducted by the team coordinated by Samantha Parker of the Boston University School of Public Health. According to the results of the survey, almost one in ten women is diagnosed as hypertensive in the year following childbirth, as proof of the changes in blood pressure control systems linked to pregnancy.
But there’s more. In this specific population, in more than 20% of cases, hypertension is identified more than six weeks after delivery, when check-ups by the gynecologist tend to be less frequent.
What the research says and who is most at risk
The study looked at over 18 women, more than one in two black women and nearly one in five Latino women, with no history of hypertension.
New onset postpartum hypertension was defined as systolic blood pressure of 140 millimeters of mercury and diastolic blood pressure above 90. Severe hypertension was considered with maximal blood pressure above 160 and/or minimum above 110 millimeters of mercury.
From the analysis of the data collected also in the following year after the birth of the baby, it was seen that 12.1% of women with no history of arterial hypertension developed hypertension in the year following the birth. But there’s more: if in the majority of cases the pathological elevation of blood pressure appeared immediately after giving birth, hypertension was recognized more than six weeks later in over one in five women.
The risk factors for this condition, according to what emerges from the analysis, would be age, with women over 35, childbirth by cesarean section and cigarette smoking. In those who had all three of these characteristics, the risk of developing hypertension after pregnancy was increased by 29%.
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Because it’s a dangerous situation
According to Parker, what emerges from the research should warn those who care for women who do not have any signs of hypertension but then may have high blood pressure after childbirth. Surprisingly, the survey reveals how in many cases hypertension manifests itself well beyond the classic periods of immediate postpartum monitoring and how it is necessary to monitor women’s cardiovascular risk at fixed intervals, even months after the birth of the baby.
It must be said that in its most serious forms, postpartum hypertension is associated with potentially very serious complications, from heart failure to the onset of stroke or renal function impairment. But above all, there is a risk of not identifying it, especially in the most socially fragile segments of the population. The study examines not so much women who already have hypertension during pregnancy, but those who manifest it later and who may still be at cardiovascular risk, perhaps not identified.
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“The study allows us to underline how not only pregnancy hypertension, i.e. the appearance of hypertension in the last trimester of pregnancy, is a risk factor for the development of subsequent hypertension, but that we must also pay attention to the possible appearance of blood pressure high or in any case higher than the threshold allowed by the guidelines at a distance from childbirth – he comments Savina NodariProfessor of Diseases of the Cardiovascular Apparatus at the University of Brescia”.
According to the expert, it is also important to note how risk profiles have been identified based on age, methods of childbirth and smoking which can help identify women to be followed more closely even at a distance. “It is true that this is a retrospective study that should also be reconfirmed by prospective studies, however the data refer to a large case series of about 2500 women with no previous history of hypertension – concludes Nodari. I think it offers a great incentive to generate pathways screening of postpartum hypertension, a risk factor that often goes unnoticed or is casually diagnosed and then treated weeks after its appearance, exposing the woman to an increased risk of cardiovascular events”.
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