title: Epidemiology and Mechanisms of De Novo and Persistent Hypertension in the Postpartum Period.
abstract: BACKGROUND
  The pathophysiology of hypertension in the immediate postpartum period is unclear.
  
  
  RESULTS
  We studied 988 consecutive women admitted to a tertiary medical center for cesarean section of a singleton pregnancy. The angiogenic factors soluble fms-like tyrosine kinase 1 and placental growth factor, both biomarkers associated with preeclampsia, were measured on antepartum blood samples. We then performed multivariable analyses to determine factors associated with the risk of developing postpartum hypertension. Of the 988 women, 184 women (18.6%) developed postpartum hypertension. Of the 184 women, 77 developed de novo hypertension in the postpartum period, and the remainder had a hypertensive disorder of pregnancy in the antepartum period. A higher body mass index and history of diabetes mellitus were associated with the development of postpartum hypertension. The antepartum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor positively correlated with blood pressures in the postpartum period (highest postpartum systolic blood pressure [r=0.29, P<0.001] and diastolic blood pressure [r=0.28, P<0.001]). Moreover, the highest tertile of the antepartum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor was independently associated with postpartum hypertension (de novo hypertensive group: odds ratio, 2.25; 95% confidence interval, 1.19-4.25; P=0.01; in the persistent hypertensive group: odds ratio, 2.61; 95% confidence interval, 1.12-6.05; P=0.02) in multivariable analysis. Women developing postpartum hypertension had longer hospitalizations than those who remained normotensive (6.5±3.5 versus 5.7±3.4 days; P<0.001).
  
  
  CONCLUSIONS
  Hypertension in the postpartum period is relatively common and is associated with prolonged hospitalization. Women with postpartum hypertension have clinical risk factors and an antepartum plasma angiogenic profile similar to those found in women with preeclampsia. These data suggest that women with postpartum hypertension may represent a group of women with subclinical or unresolved preeclampsia.
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Arvind
authors.initials: A
authors.lastname: Goel
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Manish R
authors.initials: MR
authors.lastname: Maski
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Surichhya
authors.initials: S
authors.lastname: Bajracharya
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Julia B
authors.initials: JB
authors.lastname: Wenger
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Zhang
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Saira
authors.initials: S
authors.lastname: Salahuddin
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Sajid S
authors.initials: SS
authors.lastname: Shahul
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Ravi
authors.initials: R
authors.lastname: Thadhani
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.).
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Seely
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.). sananth@bidmc.harvard.edu srana2@bsd.uchicago.edu.
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
authors.affiliation: From Division of Nephrology, Department of Medicine (A.G., M.R.M., D.Z., S.A.K.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (S.B., S.S., S.A.K., S.R.), and Division of Critical Care, Department of Anesthesiology (S.S.S.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Nephrology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.W., R.T.); Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.S.); Howard Hughes Medical Institute, Boston, MA (S.A.K.); and Section of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL (S.R.). sananth@bidmc.harvard.edu srana2@bsd.uchicago.edu.
authors.forename: Sarosh
authors.initials: S
authors.lastname: Rana
mesh_terms: D000328:Adult; D002585:Cesarean Section; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000503:physiopathology; D007902:Length of Stay / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology; D000072483:Placenta Growth Factor; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011257:Pregnancy Proteins / Q000097:blood; D011254:Pregnancy in Diabetics / Q000453:epidemiology; D011644:Puerperal Disorders / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: hypertension; postpartum; pre-eclampsia; pregnancy; receptors, vascular endothelial growth factor