Postpartum Care for Gestational Hypertension
Follow up her blood pressure, as she may require antihypertensive medication (Option B) is the correct answer. Women with gestational hypertension need structured blood pressure monitoring and potential medication management in the postpartum period, not aspirin prophylaxis for future pregnancies 1, 2, 3.
Why Blood Pressure Follow-up is Essential
Critical Monitoring Period
- Blood pressure peaks at 3-7 days postpartum, which corresponds to the highest risk period for maternal stroke and cardiovascular complications 4, 1.
- Close BP monitoring is essential for at least 3 days postpartum, as preeclampsia may develop de novo in the early postpartum period 2, 3.
- Women should not be discharged before 24 hours to ensure adequate vital sign monitoring 3.
Structured Follow-up Schedule
The American College of Obstetricians and Gynecologists (ACOG) recommends:
- BP check within 72 hours of delivery 4, 2.
- Repeat BP check within 10 days of delivery 4, 2.
- Additional visits at 7-14 days and 6 weeks postpartum 3.
- Comprehensive review at 3 months postpartum, by which time BP should have normalized 2, 3.
Home Blood Pressure Monitoring
- Daily or twice-daily home BP monitoring is recommended in the first week after discharge 4, 2.
- Some programs recommend BP monitoring 5 days per week in the first postpartum week, with decreasing frequency over 6 weeks 4.
- Text-based or Bluetooth-enabled transmission can facilitate transfer of BP values into the electronic health record 4.
Medication Management
When to Treat
- Severe hypertension (BP ≥160/110 mmHg) lasting >15 minutes requires immediate treatment within 30-60 minutes to reduce stroke risk 1, 2.
- Non-severe persistent hypertension (BP ≥140/90 mmHg) warrants oral antihypertensive therapy 1, 5.
Medication Options Compatible with Breastfeeding
For persistent non-severe hypertension:
- Nifedipine extended-release (30-60 mg once daily) is first-line 1.
- Labetalol (200-800 mg twice daily), though it may be less effective postpartum with higher readmission risk compared to calcium channel blockers 1.
- Enalapril (5-20 mg once daily) can be used unless the neonate is premature or has renal failure 1, 2.
Medications to avoid:
- Diuretics (furosemide, hydrochlorothiazide, spironolactone) may reduce milk production and should be avoided 1, 2.
- NSAIDs should be avoided for postpartum analgesia, especially in women with renal involvement, as they can worsen hypertension 1, 2.
Duration of Treatment
- Continue antihypertensive medication until BP normalizes, which typically occurs within 3 months postpartum 2.
- Women still requiring antihypertensives at discharge should be reviewed within 1 week 2, 3.
Why Aspirin is NOT the Answer
Aspirin prophylaxis (Option A) is for PREVENTION during pregnancy, not postpartum management:
- Low-dose aspirin is recommended after 12 weeks' gestation in women at high risk of preeclampsia to prevent its development 6.
- This is a preventive strategy for future pregnancies, not a treatment for current postpartum hypertension 6.
- The immediate postpartum concern is managing existing hypertension and preventing acute complications like stroke 1.
Long-term Cardiovascular Risk
Increased Future Risk
- Women with gestational hypertension have significantly elevated lifetime risk for chronic hypertension, stroke, ischemic heart disease, and thromboembolic disease 1, 2.
- They have approximately 4% risk for preeclampsia and 25% risk for gestational hypertension in future pregnancies 3.
- All women with gestational hypertension require lifelong follow-up with regular BP monitoring and periodic assessment of fasting lipids and blood sugar 3.
Postpartum Hypertension Clinics
- Multidisciplinary postpartum hypertension clinics can improve outcomes by providing active medication titration, cardiovascular risk factor screening, lifestyle counseling, and serving as a bridge to longitudinal care 4, 2.
- These clinics should address contraception planning (especially important if prescribing ACE inhibitors due to teratogenicity), mental health screening, and patient education about long-term cardiovascular implications 4, 1.
Common Pitfalls to Avoid
- Do not discharge patients without a clear BP monitoring plan for the critical first 3-7 days when BP peaks 1.
- Do not assume hypertension will resolve immediately after delivery; it may persist for days to weeks 2.
- Do not prescribe NSAIDs liberally for postpartum pain in women with hypertensive disorders 1.
- Ensure patients know when to seek help: Only 44.6% of women with hypertensive disorders of pregnancy correctly identified systolic BP of 140 mmHg as the threshold to contact a clinician 7.