Postpartum Hypertension Program at UPMC Magee-Womens Hospital: Bridging Postpartum Hypertension Care

In the few months after giving birth, 69% of women at the Postpartum Hypertension Program at UPMC Magee-Womens Hospital take antihypertensives to treat postpartum hypertension. Meanwhile, other new mothers may live with untreated postpartum hypertension—putting themselves at serious risk of heart attack, stroke, and heart failure even 10 to 15 years after delivery.

A lack of routine follow-up care seems to be part of the problem. While pregnant women are typically seen once a week by an obstetrician in the final weeks of pregnancy, new mothers typically attend one to two follow-up appointments around six weeks after delivery and are then referred to their primary care physicians. Some women are not seen for a follow-up by an obstetrician at all, only returning to care once pregnant again. 

This is a distressing reminder of the serious gaps the U.S. has in taking care of women and children—but also an area where UPMC can help. 

While management of postpartum hypertension seems to become lost during this unique period of a mother’s life, it should instead be a period of opportunity, says Malamo E. Countouris, MD, a UPMC cardiologist who studies hypertensive disorders of pregnancy and mechanisms for development of later-life cardiovascular disease. 

It is what led her and maternal-fetal medicine physician Alisse Hauspurg, MD, to create the Postpartum Hypertension Program at UPMC Magee-Womens Hospital. Modeled after the successful MotHERS Program in Canada, it is one of only a handful of clinics in the country that focuses on postpartum care for women with hypertensive disorders of pregnancy. 

At the clinic, patients are evaluated by two specialists: a maternal-fetal medicine physician and a cardiologist. With the maternal-fetal medicine specialist, patients discuss their pregnancy and delivery and undergo preconception counseling for the future. From the cardiology side, they manage ongoing hypertension, undergo cardiovascular risk-factor screening, and receive individual counseling about hypertension risks and healthy lifestyle changes to mitigate them. The doctors also have a robust referral program, linking patients with other specialists and primary care physicians.

Dr. Countouris, clinical instructor and postdoctoral scholar, Division of Cardiology, and Dr. Hauspurg, assistant professor, Department of Obstetrics, Gynecology & Reproductive Sciences, met during their fellowship training and formed a partnership with their mutual interests to improve postpartum care for high-risk women. 

Their effort to create the Postpartum Hypertension Program was supported by leadership from Kathryn Berlacher, MD, Assistant professor of medicine in the Cardiology Division, and Arun Jeyabalan, MD, associate professor in the Department of Obstetrics, Gynecology & Reproductive Science at UPMC.

The clinic was launched with the goal of serving high-risk populations, as well as underserved populations, in western Pennsylvania. Currently, 62% of patients are white and 32% are Black, with a mean age of 33. Of the women treated at the clinic, 68% have preeclampsia or gestational hypertension; 28% have chronic hypertension and superimposed preeclampsia; and 5% have peripartum cardiomyopathy. 

While all pregnant women are at risk for preeclampsia, some are at a higher risk than others, including women giving birth at an older age, those with high blood pressure or diabetes, or those who smoke or are overweight or obese. Recent work published in JAMA Network Open by Dr. Hauspurg also shows that Black women have higher blood pressure six weeks after delivery, highlighting a clear need for improved postpartum blood pressure management in this population. 

Since its inception in November 2019, the clinic has seen more than 100 patients, and each clinic day is now fully booked. Patients are referred to the clinic through OB providers, primary care physicians, cardiology consult service, and Connected Care—UPMC’s postpartum remote blood pressure monitoring program. The clinic has also secured funding from a UPMC Magee-Womens Hospital Medical Staff Grant to help subsidize transportation for patients, cover co-pays, and provide blood pressure cuffs. 

Visits are mainly conducted virtually due to the COVID-19 pandemic, but this has been convenient for mothers who have difficulty coming to the office. The clinic has achieved an impressive 84% show-rate, compared to traditional six-week postpartum visits, where as many as 40% of women are not seen in follow-up after delivery. This highlights a need for innovative models to expand care and accessibility, says Dr. Hauspurg.

To this end, the Postpartum Hypertension Program has already partnered with Connected Care, an established remote blood-pressure monitoring program at UPMC to help women monitor and manage hypertension through the first year postpartum. Once women in that program reach the four-week postpartum mark, they are sent a video about the clinic. In early 2020, Dr. Hauspurg and her collaborators harnessed some of the early data from that program to explore its effects on women with hypertension. For the study, 409 patients remotely monitored their blood pressure and submitted results through a mobile device. 

The findings demonstrated feasibility, high engagement, retention, and patient satisfaction with the program, as well as high compliance with postpartum visits. Of those studied, 83% of women continued the program beyond three weeks postpartum, 88% attended an in-person six-week postpartum visit, and 94% reported satisfaction with the program. The study results were published in the journal Obstetrics and Gynecology. 

Now, the researchers are conducting a trial to investigate how certain lifestyle interventions, such as quitting smoking or increasing exercise, can reduce hypertension. They also plan to follow this cohort of women longitudinally to better understand how hypertension treatment affects health outcomes. Also, while doctors have known about preeclampsia for decades, little research has been done to study ways to impact its long-term cardiovascular effects, say Dr. Countouris and Dr. Hauspurg. With the Postpartum Hypertension Program, they hope to change that.

While there is much research on the horizon for the Postpartum Hypertension Program, both Dr. Hauspurg and Dr. Countouris feel the clinic is filling a critical need by serving an at-risk population that could easily become forgotten. The clinic is also having a local and national effect. They are opening another clinic at UPMC Hamot in Erie to further serve at-risk populations and will serve as a model for other national institutions launching similar postpartum hypertension units.