Abstract
Introduction
Hypertensive disorders of pregnancy (HDP) are a leading cause of preventable maternal morbidity and mortality in the United States. Because blood pressure (BP) often peaks after hospital discharge, clinical guidelines recommend BP evaluation within 7 to 10 days postpartum. Yet fewer than half of postpartum individuals with HDP receive this follow-up, with the lowest rates among Black and Hispanic individuals. This integrative review aimed to identify multilevel barriers, facilitators, and predictors of timely postpartum BP follow-up using an intersectionality framework to inform equity-focused care.
Methods
PubMed, CINAHL, Scopus, and Web of Science were searched in February 2025 for studies published between May 2018 and February 2025. Eligible studies included quantitative, qualitative, or mixed-methods research that examined BP evaluation within 10 days postpartum among individuals with HDP; case reports and studies without racial/ethnic data were excluded. Thirteen studies met the criteria. Data were extracted into an evidence table, appraised with the Johns Hopkins Evidence-Based Practice model, and analyzed to identify multilevel barriers, facilitators, and predictors of follow-up.
Results
Barriers to follow-up included racial and ethnic inequities, inadequate insurance, socioeconomic disadvantage, and fragmented prenatal care. Facilitators included remote BP monitoring, nurse-led interventions, and supportive provider communication. Predictors such as HDP severity, cesarean birth, maternal age, and parity were associated with follow-up, reflecting structural and contextual influences on postpartum care engagement.
Discussion
Disparities in early postpartum BP follow-up are rooted in intersecting systems of racism, classism, and structural disadvantage. These findings align with prior research showing the benefits of remote BP monitoring but extend the literature by identifying populations that remain excluded. Equity-focused strategies, including remote BP monitoring, midwifery-led care, and policy reform, are urgently needed to improve postpartum outcomes and reduce disparities. Further research should evaluate how these strategies can be implemented to address structural barriers and engage populations most affected by HDP.