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

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.