Key Clinical Issue

What are the effectiveness, benefits, and harms of management strategies for hypertensive disorders of pregnancy during the postpartum period?

Evidence-Based Answer

Home blood pressure (BP) monitoring likely doubles the number of people who have their BP checked at recommended intervals (number needed to treat [NNT] = 2). (Strength of Recommendation [SOR]: C, disease-oriented evidence.) Patient satisfaction is high with home BP monitoring. (SOR: C, disease-oriented evidence.) Home BP monitoring likely reduces hypertension-related readmissions (NNT = 28). (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Home BP monitoring likely reduces the disparity in recommended BP monitoring by one-half between non-Black and Black patients. (SOR: C, disease-oriented evidence.) Oral furosemide may shorten the duration of postpartum hypertension (adjusted risk ratio = 0.40; CI, 0.20 to 0.81). (SOR: B, inconsistent or limited-quality patient-oriented evidence.) There is insufficient evidence on the benefits and harms of other antihypertensive medications in the postpartum period. Shorter duration magnesium sulfate (MgSO₄) leads to a shorter time from delivery to contact with the infant (mean difference = −5.4 hours; 95% CI, −10.0 to −0.80). (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Loading dose–only MgSO₄ increases the risk of recurrent seizures in patients with eclampsia (odds ratio [OR] = 2.09; 95% CI, 1.21 to 3.63). (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Lower doses of MgSO₄ decrease the risk of reduced deep tendon reflexes (OR = 0.16; 95% CI, 0.09 to 0.28).¹ (SOR: B, inconsistent or limited-quality patient-oriented evidence.)