Abstract
BACKGROUND
Hypertension is a key contributor to the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor. Hypertensive disorders of pregnancy, of which preeclampsia and eclampsia are the most common forms, have been shown to be a female-specific risk factor for chronic hypertension.
OBJECTIVE
This study aimed to determine the proportion and risk factors for persistent hypertension at 3 months after delivery among women with hypertensive disorders of pregnancy in Southwestern Uganda.
STUDY DESIGN
This was a prospective cohort study of pregnant women with hypertensive disorders of pregnancy admitted for delivery at Mbarara Regional Referral Hospital in Southwestern Uganda from January 2019 to December 2019; however, women with chronic hypertension were excluded from the study. The participants were followed up for 3 months after delivery. Participants with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg or receiving antihypertension therapy at 3 months after delivery were considered to have persistent hypertension. Multivariable logistic regression was used to determine independent risk factors associated with persistent hypertension.
RESULTS
A total of 111 participants with hypertensive disorders of pregnancy diagnosed at hospital admission were enrolled with a follow-up rate of 49% (54/111) at 3 months after delivery. Of these women, 21 of 54 (39%) had persistent hypertension 3 months after delivery. In the adjusted analyses, an elevated serum creatinine level (>106.08 µmol/L [≤1.2 mg/dL]) at admission for delivery was the only independent risk factor for persistent hypertension at 3 months after delivery (adjusted relative risk, 1.93; 95% confidence interval, 1.08–3.46; P=.03), controlling for age, gravidity, and eclampsia.
CONCLUSION
Approximately 4 of 10 women presenting with hypertensive disorders of pregnancy at our institution remained hypertensive 3 months after delivery. Innovative strategies are needed to identify these women and provide long-term care to optimize blood pressure control and reduce future cardiovascular disease after hypertensive disorders of pregnancy.
Key words: hypertension, hypertensive disorders of pregnancy, Mbarara, persistent hypertension, postpartum, preeclampsia, Uganda
AJOG Global Reports at a Glance.
Why was this study conducted?
This study aimed to determine the proportion of and risk factors for persistent hypertension at 3 months after delivery among women whose pregnancies were complicated by hypertensive disorders of pregnancy (HDP) in South-Western Uganda.
Key findings
Approximately 40% of women presenting with HDP remained hypertensive at 3 months after delivery. An elevated serum creatinine level at admission was noted to be an independent risk factor for persistent hypertension 3 months after delivery.
What does this add to what is known?
This study demonstrated that, in South-Western Uganda, a high proportion of women remain hypertensive after pregnancy-induced hypertension and that women with a high creatinine level in pregnancy are at an elevated risk of persistent hypertension after delivery.
Introduction
Hypertension is a key driver of the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor.1 Globally, 7.6 million premature deaths are attributed to high blood pressure, and 80% of these deaths occurred in low- and middle-income countries (LMICs).2 Evidence suggests that the burden of disease because of hypertension will increase by 60%, and most of the affected people will be in low-income countries.2,3
Hypertensive disorders of pregnancy (HDP), of which preeclampsia and eclampsia are the most common forms, are associated with chronic hypertension.4 Preeclampsia or eclampsia affects at least 2% to 10% of all pregnant women5,6 and accounts for the severe complications of pregnancy resulting in more than 70,000 maternal deaths per year, most of which are in LMICs.7 Moreover, HDP are the second leading cause of mortality at Mbarara Regional Referral Hospital, a tertiary care hospital in Southwestern Uganda.8
HDP usually resolve within 3 months after delivery in most women.9,10 Several studies from high-income countries have followed up women with HDP and demonstrated a long-term risk of developing chronic hypertension, diabetes mellitus, and cardiovascular disease11,12 in affected women and their offspring.1 Furthermore, studies10,13, 14, 15, 16 have clarified risk factors for persistent hypertension in women after the immediate postpartum period. However, studies of HDP from Uganda and other sub-Saharan African countries are limited by a short follow-up period of up to 6 weeks15,17,18 and are lacking in laboratory tests.14
Therefore, we sought to describe persistent hypertension in a prospective cohort of women delivering in rural Uganda and determine the proportion of and risk factors for persistent hypertension at 3 months after delivery among women with HDP at Mbarara Regional Referral Hospital.
Materials and Methods
Study design and setting
This was a prospective cohort study of women with HDP admitted for delivery at Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda from January 2019 to December 2019. MRRH is a government-funded public hospital that performs approximately 9000 deliveries per year and is a teaching hospital for Mbarara University of Science and Technology. MRRH is a tertiary care facility that serves a population of 5 million people from 10 catchment districts in Southwestern Uganda.19
Participants
Details of the study cohort have been described in a previous publication.20 Briefly, our study population included all pregnant women, including those under the age of 18 years, at ≥20 weeks of gestation with new-onset hypertension in pregnancy diagnosed at admission. Normotensive women at admission who later developed elevated blood pressure during their labor course or postpartum course were not included in the study. We defined hypertension as 2 blood pressure readings with either a systolic blood pressure (SBP) of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg measured 4 hours apart. Women reporting a history of hypertension before pregnancy or before 20 weeks of gestation diagnosed by a healthcare provider or taking antihypertensive medication before pregnancy were considered to have chronic hypertension and excluded from participation.
To determine eligibility, all pregnant women admitted to the maternity ward of MRRH for delivery had a screening blood pressure measured by the research staff on admission. Women with elevated blood pressure at admission had a subsequent check 4 hours later. Women who met the inclusion criteria were consented and enrolled in the study, followed up during their delivery and on discharge, and followed up to 3 months after delivery. To obtain information on their sociodemographic background and medical history, the enrolled women were interviewed during their admission and were also invited back to the hospital 3 months after delivery for an interview and blood pressure measurement by trained study staff.
Variables and data sources
We classified enrolled women a priori as those with gestational hypertension, preeclampsia, preeclampsia with severe features, and eclampsia at admission. Gestational hypertension was defined as new-onset hypertension without proteinuria. Preeclampsia was defined as new-onset hypertension with proteinuria. The study team assessed for proteinuria (defined as ≥2+ protein) in all enrolled women at admission using a dipstick of a midstream urine sample. Severe features of preeclampsia included any of the following: SBP of ≥160 mm Hg or DBP of ≥110 mm Hg, ≥3+ protein by dipstick, persistent epigastric pain, persistent headache, visual changes, or elevated serum creatinine level.7,21 A blood sample was drawn at recruitment for study purposes and analyzed for renal (serum creatinine and urea levels) function and lipid profile. Women with preeclampsia who presented with, or developed, grand mal seizures and had no known existing or preexisting neurologic condition were defined as having eclampsia.22
Outcomes
The primary outcome was persistent hypertension at 3 months after delivery. This was defined as an SBP of ≥140 mm Hg or a DBP of ≥90 mm Hg or receiving antihypertensive medication at 3 months after delivery.
Other covariates of interest included sociodemographic factors: maternal age, marital status, level of education, and referral status (ie, women referred to MRRH from another health center for delivery). Medical history included HIV status (HIV-positive or HIV-negative result done within 3 months), known history of chronic kidney disease, and history of diabetes mellitus. Prepregnancy body mass index (BMI) was not available; however, we measured the weight and height at enrollment to the study and calculated the BMI (weight in kilograms divided by height in meters squared) from this measurement. Obstetrical data collected included gravidity, mode of delivery, gestational age at delivery (determined primarily using the last normal menstrual period [LNMP] or first-trimester obstetrical ultrasound scan if available; however, LNMP was unknown), and history of hypertension in previous pregnancies. This information was obtained using an interviewer-administered questionnaire during participant enrollment and a second questionnaire administered 3 months after delivery. Moreover, we performed the following laboratory tests with the following limits of normal set a priori: serum creatinine level (≤106.08 µmol/L [≤1.2 mg/dL]),23 triglyceride level (2.48 mmol/L), total cholesterol level (5.89 mmol/L), low-density lipoprotein level (3.62 mmol/L), and high-density lipoprotein (HDL) level (0.91 mmol/L).24
Study data were collected and managed using Research Electronic Data Capture (REDCap) tools hosted at Mbarara University of Science and Technology, Department of Obstetrics and Gynecology. REDCap is a secure, Web-based software platform designed to support data capture for research studies.25
Data analysis
Maternal sociodemographic, medical, obstetrical, and laboratory tests were presented in frequency tables stratified by the primary outcome. Univariate analysis for the risk of persistent hypertension was performed using the chi-square test. Factors with a P value of ≤.2 in univariate analyses were considered for inclusion in the adjusted analysis. Multivariable logistic regression models were used to determine independent risk factors for persistent hypertension with their corresponding 95% confidence intervals (CIs).26 A P value of <.05 was considered statistically significant. Data analysis was performed using Stata (version 15; StataCorp, College Station, TX).
Ethical consideration
The study procedures were approved by the Mbarara University Research Ethics Committee (September 7, 2018), Uganda National Council for Science and Technology (HS 2570), and Partners Healthcare Institutional Review Board (2019P001446). All study participants provided written informed consent.
Results
There were 9946 deliveries from January 2019 to December 2019. Of the participants included in the study, 169 presented with HDP, 14 were excluded because they had chronic hypertension, and 44 declined consent. Therefore, we enrolled 111 participants in this study. Of the participants, 5 (4.5%) had gestational hypertension, 2 (1.8%) had preeclampsia without severe features, 79 (71.2%) had preeclampsia with severe features, and 25 (22.5%) had eclampsia. There were 54 participants who attended the study visit 3 months after delivery. The proportion of women who were hypertensive at 3 months after delivery was 39% (21/54).
Most of the participants were <35 years of age (93/111 [84.8%]), had been referred from other health units (71/111 [64%]), and were at ≥34 weeks of gestation at delivery as shown in Table 1. Most of the participants delivered by cesarean delivery (70/111 [63.1%]) and had preeclampsia with severe symptoms (93/111 [83.8%]).
Table 1.
Participant characteristics and association with persistent postpartum hypertension
| Characteristics | Total (N=111), n (%) | Normotensive at 3 mo (n=33), n (%) | Persistent hypertension at 3 mo (n=21), n (%) | P value | |
|---|---|---|---|---|---|
| Age (y) | <35 | 93 (83.8) | 28 (84.8) | 16 (76.2) | .49 |
| ≥35 | 18 (16.2) | 5 (15.2) | 5 (23.8) | ||
| Marital status | Single | 7 (6.3) | 2 (6.1) | 1 (4.8) | .84 |
| Married | 104 (93.7) | 31 (93.9) | 20 (95.2) | ||
| Level of education | Primary and below | 55 (49.6) | 13 (39.4) | 10 (47.6) | .55 |
| Secondary and above | 56 (50.4) | 20 (60.6) | 11 (52.4) | ||
| Gravidity | Primigravida | 40 (36.0) | 16 (48.5) | 4 (19.1) | .03 |
| Multigravida | 71 (64.0) | 17 (51.5) | 17 (80.9) | ||
| History of HDP in a previous pregnancy | No | 97 (87.4) | 31 (93.9) | 18 (85.7) | .31 |
| Yes | 14 (12.6) | 2 (6.1) | 3 (14.3) | ||
| Gestational age at delivery (n=103) | ≥34 | 66 (64.1) | 22 (66.7) | 12 (57.1) | .48 |
| <34 | 37 (35.9) | 11 (33.3) | 9 (42.9) | ||
| Mode of delivery | Vaginal delivery | 41 (36.9) | 11 (33.3) | 9 (42.9) | .48 |
| Cesarean delivery | 70 (63.1) | 22 (66.7) | 12 (57.1) | ||
| HIV status | Positive | 7 (6.3) | 4 (12.1) | 1 (4.8) | .36 |
| Negative | 104 (93.7) | 29 (87.9) | 20 (95.2) | ||
| Body mass index at admission (n=109) | <25 | 35 (32.1) | 10 (30.3) | 7 (33.3) | .82 |
| ≥25 | 74 (67.9) | 23 (69.7) | 14 (66.7) | ||
| Referral from another facility | Not referred | 40 (36.0) | 13 (39.4) | 8 (38.1) | .92 |
| Referred | 71 (64.0) | 20 (60.6) | 13 (61.9) | ||
| Preeclampsia with severe features at admission | Asymptomatic | 18 (16.2) | 4 (12.1) | 3 (14.3) | .82 |
| Symptomatic | 93 (83.8) | 29 (87.9) | 18 (85.7) | ||
| Severe systolic blood pressure at admission (mm Hg) | <160 | 56 (50.4) | 16 (48.5) | 7 (33.3) | .27 |
| ≥160 | 55 (49.6) | 17 (51.5) | 14 (66.7) | ||
| Severe diastolic blood pressure at admission (mm Hg) | <110 | 61 (54.9) | 16 (48.5) | 8 (38.1) | .45 |
| ≥110 | 50 (45.1) | 17 (51.5) | 13 (61.9) | ||
| Proteinuria (≥2+ by urine dipstick) at admission | Absent | 36 (32.4) | 9 (27.3) | 8 (38.1) | .40 |
| Present | 75 (67.6) | 24 (72.7) | 13 (61.9) | ||
| Eclampsia | No | 86 (77.5) | 24 (72.7) | 19 (90.5) | .11 |
| Yes | 25 (22.5) | 9 (27.3) | 2 (9.5) | ||
| Serum creatinine level at admission (µmol/L) | ≤106.08 | 91 (82.0) | 29 (87.9) | 14 (66.7) | .06 |
| >106.08 | 20 (18.0) | 4 (12.1) | 7 (33.3) | ||
| Total cholesterol level (mmol/L) | Normal | 96 (86.5) | 28 (84.9) | 18 (85.7) | .93 |
| Elevated | 15 (13.5) | 5 (15.1) | 3 (14.3) | ||
| Triglyceride level (mmol/L) | Normal | 98 (88.3) | 28 (84.9) | 18 (85.7) | .93 |
| Elevated | 13 (11.7) | 5 (15.1) | 3 (14.3) | ||
| LDL level (mmol/L) | Normal | 104 (93.7) | 31 (93.9) | 21 (100) | .25 |
| Elevated | 7 (6.3) | 2 (6.1) | 0 (0) | ||
| HDL level (mmol/L) | Normal | 87 (78.4) | 30 (90.9) | 19 (90.5) | .96 |
| Low | 24 (21.6) | 3 (9.1) | 2 (9.5) | ||
HDL, high-density lipoprotein; HDP, hypertensive disorders of pregnancy; LDL, low-density lipoprotein.
Lugobe. Persistent hypertension at three months postpartum among women with hypertensive disorders of pregnancy. Am J Obstet Gynecol Glob Rep 2023.
Baseline characteristics for most of the participants who were lost to follow-up at 3 months after delivery were not significantly different from those who attended the follow-up visit except for the district of origin (P<.01), DBP (P=.03), and HDL level (P<.01), as shown in Table 2.
Table 2.
Comparison between participants who attended and those who missed the follow-up visit at 3 months after delivery
| Characteristics | Total (N=111), n (%) | Attended visit (n=54), n (%) | Missed visit (n=57), n (%) | P value | |
|---|---|---|---|---|---|
| Age (y) | <35 | 93 (83.8) | 44 (81.5) | 49 (86.0) | .52 |
| ≥35 | 18 (16.2) | 10 (18.5) | 8 (14.0) | ||
| Marital status | Single | 7 (6.3) | 3 (5.6) | 4 (7.0) | .75 |
| Married | 104 (93.7) | 51 (94.4) | 53 (93.0) | ||
| Level of education | Primary and below | 55 (49.6) | 23 (42.6) | 32 (56.1) | .15 |
| Secondary and above | 56 (50.4) | 31 (57.4) | 25 (43.9) | ||
| District of origin | Not within Mbarara | 48 (43.2) | 16 (29.6) | 32 (56.1) | <.01 |
| Within Mbarara | 63 (56.8) | 38 (70.4) | 25 (43.9) | ||
| Gravidity | Primigravida | 40 (36.0) | 20 (37.0) | 20 (35.1) | .83 |
| Multigravida | 71 (64.0) | 34 (63.0) | 37 (64.9) | ||
| History of HDP in a previous pregnancy | No | 97 (87.4) | 49 (90.7) | 48 (84.2) | .30 |
| Yes | 14 (12.6) | 5 (9.3) | 9 (15.8) | ||
| Gestational age at delivery (n=103) | ≥34 | 66 (64.1) | 34 (63.0) | 32 (65.3) | .80 |
| <34 | 37 (35.9) | 20 (37.0) | 17 (34.7) | ||
| Mode of delivery | Vaginal delivery | 41 (36.9) | 20 (37.0) | 21 (36.8) | .98 |
| Cesarean delivery | 70 (63.1) | 34 (63.0) | 36 (63.2) | ||
| HIV status | Positive | 7 (6.3) | 5 (9.3) | 2 (3.5) | .21 |
| Negative | 104 (93.7) | 49 (90.7) | 55 (96.5) | ||
| Body mass index at admission (n=109) | <25 | 35 (32.1) | 17 (31.5) | 18 (32.7) | .89 |
| ≥25 | 74 (67.9) | 37 (68.5) | 37 (67.3) | ||
| Referral from another facility | Not referred | 40 (36.0) | 21 (38.9) | 19 (33.3) | .54 |
| Referred | 71 (64.0) | 33 (61.1) | 38 (66.7) | ||
| Preeclampsia with severe features at admission | Asymptomatic | 18 (16.2) | 7 (13.0) | 11 (19.3) | .37 |
| Symptomatic | 93 (83.8) | 47 (87.0) | 46 (80.7) | ||
| Severe systolic blood pressure at admission (mm Hg) | <160 | 56 (50.4) | 23 (42.6) | 33 (57.9) | .11 |
| ≥160 | 55 (49.6) | 31 (57.4) | 24 (42.1) | ||
| Severe diastolic blood pressure at admission (mm Hg) | <110 | 61 (54.9) | 24 (44.4) | 37 (64.9) | .03 |
| ≥110 | 50 (45.1) | 30 (55.6) | 20 (35.1) | ||
| Proteinuria (≥2+ by urine dipstick) at admission | Absent | 36 (32.4) | 17 (31.5) | 19 (33.3) | .84 |
| Present | 75 (67.6) | 37 (68.5) | 38 (66.7) | ||
| Eclampsia | No | 86 (77.5) | 43 (79.6) | 43 (75.4) | .59 |
| Yes | 25 (22.5) | 11 (20.4) | 14 (24.6) | ||
| Serum creatinine level at admission (µmol/L) | ≤106.08 | 91 (82.0) | 43 (79.6) | 48 (84.2) | .53 |
| >106.08 | 20 (18.0) | 11 (20.4) | 9 (15.8) | ||
| Total cholesterol level (mmol/L) | Normal | 96 (86.5) | 46 (85.2) | 50 (87.7) | .70 |
| Elevated | 15 (13.5) | 8 (14.8) | 7 (12.3) | ||
| Triglyceride level (mmol/L) | Normal | 98 (88.3) | 46 (85.2) | 52 (91.2) | .32 |
| Elevated | 13 (11.7) | 8 (14.8) | 5 (8.8) | ||
| LDL level (mmol/L) | Normal | 104 (93.7) | 52 (96.3) | 52 (91.2) | .27 |
| Elevated | 7 (6.3) | 2 (3.7) | 5 (8.8) | ||
| HDL level (mmol/L) | Normal | 87 (78.4) | 49 (90.7) | 38 (66.7) | <.01 |
| Low | 24 (21.6) | 5 (9.3) | 19 (33.3) | ||
HDL, high-density lipoprotein; HDP, hypertensive disorders of pregnancy; LDL, low-density lipoprotein.
Lugobe. Persistent hypertension at three months postpartum among women with hypertensive disorders of pregnancy. Am J Obstet Gynecol Glob Rep 2023.
An elevated serum creatinine level at admission was the only independent risk factor for persistent hypertension at 3 months after delivery (adjusted relative risk, 1.93; 95% CI, 1.08–3.46) after controlling for age, gravidity, and eclampsia, as shown in Table 3. No other considered factor was predictive of persistent postpartum hypertension.
Table 3.
Risk factors for persistent hypertension at 3 months after delivery
| Characteristic | Crude OR (95% CI) | P value | Adjusted OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Age (y) | <35 | 1 | 1 | ||
| ≥35 | 1.38 (0.66–2.86) | .42 | 0.96 (0.45–2.08) | .93 | |
| Gravidity | Primigravida | 1 | 1 | ||
| Multigravida | 2.50 (1.00–6.39) | .03 | 2.19 (0.87–5.48) | .09 | |
| Eclampsia | No | 1 | 1 | ||
| Yes | 0.40 (0.11–1.51) | .11 | 0.40 (0.11–1.38) | .15 | |
| Serum creatinine level at admission (µmol/L) | ≤106.08 | 1 | 1 | ||
| >106.08 | 1.95 (1.05–3.63) | .06 | 1.93 (1.08–3.46) | .03 | |
CI, confidence interval; OR, odds ratio.
Lugobe. Persistent hypertension at three months postpartum among women with hypertensive disorders of pregnancy. Am J Obstet Gynecol Glob Rep 2023.
Discussion
Principal findings
Our study showed that approximately 40% of women with an HDP admitted to this tertiary care facility in rural Uganda remained hypertensive at 3 months after delivery, which was more likely among women with elevated creatinine levels at admission.
Results
Here, the proportion of women remaining hypertensive at 3 months after delivery was comparable with the proportion of women with preeclampsia delivering at Mulago National Referral Hospital in Uganda (34%).14 However, the proportion of persistent hypertension was higher than that found in Cameroon (28.0%),13 Cuba (27.8%),27 or Egypt (12.1%).28 The differences in study settings and the severity of preeclampsia among the participants studied could, in part, explain our high rate of persistent hypertension.
An elevated serum creatinine level at admission was the only factor associated with persistent hypertension at 3 months after delivery in adjusted models, which is similar to what was found in other studies.15,23,27 This could be due to endothelin, a potent endogenous vasoconstrictor peptide produced by endothelial cells, which may result in endothelial dysfunction. Persistently elevated endothelin levels are associated with diminished creatinine clearance.29 The renal insult secondary to vasospasm might lead to ischemic injury to the kidney and triggering of the renin-aldosterone-angiotensin feedback.30 This might be one of several potential factors involved in the pathogenesis of chronic hypertension among these women with preeclampsia. An elevated creatinine level as a known marker of chronic kidney disease may reflect in women who had undiagnosed asymptomatic kidney disease or chronic hypertension before pregnancy or kidney injury after preeclampsia. In an observational study of women with preeclampsia, women with elevated serum creatinine levels have had hypertension in the previous pregnancy.31 Therefore, it is not clear whether these are women who could have had undiagnosed hypertension or kidney disease at the start of their current pregnancy that remained hypertensive at follow-up after delivery as chronic hypertension and kidney disease are risk factors for persistent hypertension. Moreover, it is plausible that chronic hypertension and preeclampsia may have similar or related risk factors.
Clinical implications
Our findings have implications for healthcare delivery in this population. The high proportion of women with hypertension at 3 months after delivery indicates a need for new models of care in this region with longer follow-up periods, linkage to long-term hypertension clinics for care, and prenatal care visits before subsequent pregnancies. This linkage to care will be important not only to optimize preconception and prenatal care in subsequent pregnancies, with improved maternal and perinatal outcomes, but also to prevent or mitigate long-term cardiovascular disease. In addition, consideration should be given to measuring serum creatinine levels at admission in women with a hypertensive disorder and longer postpartum follow-up for those with elevated serum creatinine levels. Given the small sample size in this study, further research to understand the risk factors for persistent hypertension and the use of these risk factors in the decision-making for the length of follow-up is needed.
Research implications
Larger prospective and multicenter studies should be conducted to clarify other possible risk factors for persistent hypertension in this setting with attention given to how to implement follow-up of women after delivery and to ensure linkage to long-term care for those with an established diagnosis of chronic hypertension and preventative care for those planning future pregnancies. Moreover, studies should be conducted to determine the barriers and facilitators of postpartum follow-up and interventional studies to enhance postpartum follow-up.
Strengths and limitations
Our study strengths included a prospective study design, a clear assignment of HDP, a follow-up to 3 months after delivery, and the performance of laboratory tests.
However, we had some limitations. Loss to follow-up was high at 12 weeks. We assessed for differences in those lost to follow-up as reported, but there may be other unmeasured systematic differences in those lost to follow-up that may influence the incidence of persistent hypertension found in this study. Our relatively small sample size limited our multivariable analysis; therefore, other risk factors may exist that were not clarified in this study. We did not measure liver enzymes and platelet counts. Therefore, we were not able to determine whether the condition of hemolysis, elevated liver enzymes, and low platelet count is a risk factor.
Conclusions
Nearly 4 of 10 women with an HDP at delivery remained hypertensive beyond the immediate postpartum period, particularly women admitted with elevated serum creatinine levels. There is a need for longer follow-up of women whose pregnancies have been complicated by hypertension. Larger prospective studies in sub-Saharan Africa should be instituted to understand the long-term cardiovascular health of these women.
Acknowledgments
The authors would like to appreciate the research assistants Ms Patience Naiga, Ms Florida Tusiimiraho, Dr Daphine Kibanda, Dr Ruth Grace Kakoba, and Dr Twesigomwe Godfrey. We acknowledge the staff at the maternity ward of Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, and all the study participants. We give special thanks to the members of the training advisory committee of Mbarara University Research Training Initiative for the guidance offered during the study.
Footnotes
The authors report no conflict of interest.
Patient consent is not required because no personal information or detail was included.
Research reported in this publication was supported by the Fogarty International Center and cofounding partners (National Institutes of Health [NIH] Common Fund, Office of Strategic Coordination, Office of the Director; NIH Office of AIDS Research, Office of the Director; National Institute of Mental Health; and National Institute of Neurological Disorders and Stroke) of the NIH under award number D43TW010128 to H.M.L. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
H.M.L. is funded by the Commonwealth Trust.
The research reported here was funded by the Commonwealth Scholarship Commission and the Foreign, Commonwealth and Development Office in the UK to HML. I am grateful for their support. All views expressed here are those of the author(s) not the funding body.
This research was supported, in part, by the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
The funders had no role in the study design, data collection, and analysis; decision to publish; or preparation of the manuscript.
This study was presented at the 42nd annual meeting of the Society for Maternal-fetal Medicine, Kissimmee, FL, January 31, 2022, to February 5, 2022.
Cite this article as: Lugobe HM, Kayondo M, Mceniery CM, et al. Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda. Am J Obstet Gynecol Glob Rep 2023;XX:x.ex–x.ex.
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