Abstract
Background
To assess the impact of a maternal cardiovascular (CV) and blood pressure (BP) screening and standardized referral protocol at newborn visits on care utilization in the first 12 weeks postpartum.
Methods
This prospective quality improvement initiative obtained maternal vital signs and CV symptoms at a pediatric academic practice. Elevated BP (≥140/90 mmHg) triggered enrollment into a remote BP management program, on-call Maternal-Fetal Medicine or Cardiology physician consultation, and/or emergency department (ED) referral. Unmatched control group were postpartum individuals of newborns seen on non-screening days in the same clinic. Outcomes included postpartum visit attendance, ED visits, readmissions, new postpartum hypertension (HTN) diagnosis, remote BP monitoring program enrollment, and postpartum antihypertensive initiation. Multivariable logistic regression was used to calculate odds ratios for postpartum care utilization outcomes and adjusted for demographic differences between groups (parity, BMI, gestational age, smoking) and other covariates related to postpartum care utilization (age, insurance, preexisting HTN). Interaction analyses tested effect modification by preexisting HTN status, with predictive margins calculated when significant using chi-square tests.
Results
We included 132 screened individuals and 248 controls (77.9% non-White, 76.3% publicly insured). Among those screened, 34.1% (n = 45) had elevated BP, with 38.7% (n = 17) having no prior HTN diagnosis. Among screened participants with known HTN (n = 45), 62.2% (n = 28) had elevated BP at screening. The intervention group had significantly higher rates of newly diagnosed postpartum HTN (20.7% vs. 8.2%, p < 0.01). After adjustment, the intervention had no effect on postpartum visit attendance (OR 1.05, 95% CI 0.62–1.78), but reduced the odds of ED visits (OR 0.52, 95% CI 0.29–0.95) and readmissions (OR 0.31, 95% CI 0.11–0.95). For those with preexisting HTN, acute care utilization was similar between groups (ED visits—χ2 = 0.56, p = 0.45; readmissions—χ2 = 0.18, p = 0.66).
Conclusion
This intervention detected more postpartum HTN while being associated with decreased odds of ED visits and readmissions. Acute care usage was similar for those with existing HTN, despite high rates of uncontrolled HTN at screening. This suggests maternal BP screening at newborn visits paired with remote BP monitoring may improve our postpartum patient outreach and be more feasible than traditional care while reducing acute care needs.