Postpartum Blood Pressure Screening in the United States Primary Care Settings: A Systematic Review

Abstract

Background: Timely blood pressure (BP) screening is not consistently performed for new mothers. Only 60% complete a 6-week postpartum visit, and even fewer are evaluated within 1 week. This timing is crucial since mortality is highest in the first 6 days. Primary care has a role to play in improving postpartum BP care. However, research has yet to fully explore primary care-driven strategies for postpartum BP screening.

Objective: This review aims to identify primary care postpartum BP screening strategies and to understand the characteristics of patients who are completing BP screenings within 1 week.

Methods: We used the PubMed and Web of Science databases to identify peer-reviewed studies published since 2010. Included studies were conducted in the United States and of English-language publications.

Results: We identified 13,452 articles and synthesized 32 studies. Of 11,270 postpartum patients, 40% (n = 4,790) identified as Black/African American race. For recruitment, 24 (75.0%) studies focused on high-risk patients, 5 (15.6%) compared high-risk to low-risk patients, and 3 (9.4%) studies recruited all patients with no restrictions. Studies often reported BP ascertainment within 1-week postpartum (53.1%; n = 17). Further, 12 (37.5%) studies incorporated both in-clinic and in-home settings for postpartum BP screening, 10 (31.2%) were in-clinic, and 10 (31.2%) were in-home.

Conclusions: We found that primary care systems are evaluating BP within 1-week postpartum, leveraging remote BP monitoring and child-wellness checks. Those strategies, however, less often included low-risk patients. Updated guidelines are needed to cover postpartum BP screening for patients with uncomplicated pregnancies and the absence of other risk factors.

Keywords: blood pressure; hypertension; postpartum; primary care.