UPMC Experts Work to Bridge Gap in Care Through Postpartum Hypertension Program

UPMC cardiovascular and maternal fetal medicine experts are collaborating to improve care for women who experience hypertensive disorders of pregnancy. For women in the United States, there is a gap between routine care with their obstetrician and longer-term care to treat cardiovascular diseases like hypertension – the Postpartum Hypertension Program is working to bridge that gap in care. 

The Postpartum Hypertension Program, run by Malamo Countouris, MD, co-director; Alisse Hauspurg, MD, co-director; Katie Berlacher, MD, medical director, UPMC Magee-Womens Heart Program; and Arun Jeyabalan, MD, director, Division of Maternal Fetal Medicine, is a multidisciplinary collaboration between the Department of Maternal Fetal Medicine and the UPMC Magee-Womens Heart Program. 

The program – one of only a handful of clinics of its kind in the United States – offers individualized care to women after delivery who are experiencing high blood pressure, in addition to cardiovascular risk factor screening and consultations on risk reduction for future pregnancies.

Experts at the program collaborate with other specialists and primary care physicians to ensure that women receive comprehensive cardiovascular care throughout all stages of their lives. 

“Postpartum hypertension clinics like ours can help improve blood pressure control, reduce disparities in care, and improve transitions in care,” Dr. Countouris says. “If you have patients that have a hypertensive disorder of pregnancy and think they might benefit from being seen by our clinic, we are more than happy to see them.”

Hypertensive Disorders of Pregnancy

Hypertensive disorders complicate between 10% to 20% of pregnancies. These disorders include gestational hypertension, preeclampsia, and eclampsia, and experiencing them significantly increases a woman’s risk for future cardiovascular disease.

Of women who experience a hypertensive disorder during pregnancy, 40% will develop hypertension within five years. Hypertensive disorders are the most common reason for postpartum hospitalization, and frighteningly, half of maternal deaths occur after delivery, many due to cardiovascular complications like preeclampsia. This is even more concerning as the maternal mortality rate in the United Sates has doubled in the past two decades. 

Women of color are disproportionately impacted from pregnancy and cardiovascular complications. Black women are more likely to experience preeclampsia than White women, for example, and the maternal mortality rate for non-Hispanic Black women is three times that of non-Hispanic White women. 

Dr. Berlacher highlighted the importance of asking patients about their timing of menarche, if they have polycystic ovarian syndrome (PCOS), pregnancy history, and timing of menopause, since complications with these can increase a woman’s risk of future cardiovascular disease. 

Home Blood Pressure Monitoring with the Vivify Program

Since its inception in November 2019, more than 170 patients have been scheduled for an appointment at the program, and of the 170 scheduled, 140 patients attended their appointments. The population seen at the clinic is racially, ethnically, and geographically diverse. 

“That’s an 81% show rate at our clinic compared with the national average of postpartum visits that’s about 60%,” Dr. Countouris says. “I think that goes to show that we’re providing a need for women that was otherwise unmet.”

Most patients seen at the clinic suffer from preeclampsia, followed by 33% that have chronic hypertension and 6% with peripartum cardiomyopathy. 

Women at the program have access to home blood pressure monitoring. Through the Connected Care program, patients are given the necessary equipment to take their blood pressure at home, which they can transmit via text message to an online portal multiple times per week. They can also answer questions about how they are feeling and any other symptoms they are experiencing and medications they are taking. A team of nurses from the UPMC Heart and Vascular Institute monitors the program and responds to any abnormal blood pressure readings or symptoms. 

The program has made patients feel like they have a greater sense of control over their blood pressure. It also provides educational materials about blood pressure, stress, eating a healthy diet, exercise, and other factors that can impact cardiovascular health.

Experts at the Postpartum Hypertension Program have extensive experience in diagnosing and managing hypertensive disorders of pregnancy. The team employs a postpartum care model to achieve the overall goals of the clinic:

• To establish feasibility of a postpartum collaborative clinic for women with hypertensive disorders of pregnancy at Magee-Womens Hospital.
• To improve adherence to follow-up appointments in the first year postpartum.
• Improve cardiovascular risk factor screening, education, and modification in the first year postpartum.

For more information or to refer a patient to the Postpartum Hypertension Program, email HVIReferral@upmc.edu.