Persistent Hypertension Up to One Year Postpartum among Women with Hypertensive Disorders in Pregnancy in a Low-Resource Setting: A Prospective Cohort Study
Salisu M. Ishaku,
Tukur Jamilu,
Agbo P. Innocent,
Kayode A. Gbenga,
Dattijo Lamaran,
Oyeneyin Lawal,
Charlotte E. Warren,
Owa O. Olorunfemi,
Hanifah D. Abubakar,
Tunau Karima,
Odusolu O. Patience,
Abdulkarim Musa,
Onyebuchi K. Azubuike,
Aminu M. Baffah,
Arie Franx,
Diederick E. Grobbee,
Joyce L. Browne
Affiliations
Salisu M. Ishaku
Population Council Nigeria, NG; Julius Global Health, Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht University
Tukur Jamilu
Bayero University/Aminu Kano Teaching Hospital Kano, Kano State
Agbo P. Innocent
Population Council Nigeria
Kayode A. Gbenga
Julius Global Health, Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht University, NL; Institute of Human Virology, Abuja
Dattijo Lamaran
Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi State
Oyeneyin Lawal
University of Medical Sciences Teaching Hospital, Ondo, Ondo State
Charlotte E. Warren
Population Council-Washington DC
Owa O. Olorunfemi
Mother and Child Hospital, Akure
Hanifah D. Abubakar
Muhammad Abdullahi Wase Teaching Hospital, Kano, Kano State
Tunau Karima
Usman DanFodio University Teaching hospital, Sokoto, Sokoto State
Odusolu O. Patience
University of Calabar Teaching Hospital, Calabar, Cross River State
Abdulkarim Musa
Federal Medical Center, Lokoja, Kogi State
Onyebuchi K. Azubuike
Federal Teaching Hospital, Abakaliki, Ebonyi State
Aminu M. Baffah
Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi State
Arie Franx
Erasmus Medical Center, University Medical Center Rotterdam
Diederick E. Grobbee
Julius Global Health, Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht University
Joyce L. Browne
Julius Global Health, Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht University
Background: Hypertensive disorders in pregnancy (HDPs) are associated with lifelong cardiovascular disease risk. Persistent postpartum hypertension in HDPs could suggest progression to chronic hypertension. This phenomenon has not been well examined in low- and middle-income countries (LIMCs), and most previous follow-ups typically last for maximally six weeks postpartum. We assessed the prevalence of persistent hypertension up to one year in women with HDPs in a low resource setting and determined associated risk factors. Methodology: A prospective cohort study of women conducted at eight tertiary health care facilities in seven states of Nigeria. Four hundred and ten women with any HDP were enrolled within 24 hours of delivery and followed up at intervals until one year postpartum. Descriptive statistics were performed to express the participants’ characteristics. Univariable and multivariable logistic regressions were conducted to identify associated risk factors. Results: Of the 410 women enrolled, 278 were followed up to one year after delivery (follow-up rate 68%). Among women diagnosed with gestational hypertension and pre-eclampsia/eclampsia, 22.3% (95% CI; 8.3–36.3) and 62.1% (95% CI; 52.5–71.9), respectively, had persistent hypertension at six months and this remained similar at one year 22.3% (95% CI; 5.6–54.4) and 61.2% (95% CI; 40.6–77.8). Maternal age and body mass index were significant risk factors for persistent hypertension at one year [aORs = 1.07/year (95% CI; 1.02–1.13) and 1.06/kg/m2 (95% CI; 1.01–1.10)], respectively. Conclusion: This study showed a substantial prevalence of persistent hypertension beyond puerperium. Health systems in LMICs need to be organized to anticipate and maintain postpartum monitoring until blood pressure is normalized, or women referred or discharged to family physicians as appropriate. In particular, attention should be given to women who are obese, and or of higher maternal age.
