Pitt study examines racial differences in postpartum blood pressure

Lying on a stretcher in the back of an ambulance was when the severity of the moment hit Tyarra Kelly.

It was 3 a.m.

Her blood pressure was high.

The new mom hadn’t been feeling well five days after her son Tristan’s birth seven months ago.

“I was having trouble sleeping. So, being a health care worker, I decided to take my blood pressure,” the Monroeville resident said. “It was high for me so I decided to go UPMC East, which was close by. The doctor told me I had high blood pressure and I needed to go to the hospital. I told him I would drive there, and he said, ‘no, you could have a seizure. I am calling an ambulance.’ Being in that ambulance was terrifying.”

Courtesy of Tyarra Kelly

Tyarra (left) and Troy Kelly hold their son, Tristan. Tyarra Kelly was diagnosed with hypertension after delivery.

Kelly, 34, was diagnosed with hypertension and prescribed medication. She considers herself fortunate.

What happened to her came as a surprise, but it’s not unusual for Black women to experience postpartum high blood pressure. Studies have found in the weeks after giving birth, some Black mothers have a less rapid decline in blood pressure than white women.

Black women are more likely to die from pregnancy-related complications, according to research at the University of Pittsburgh School of Medicine and UPMC Magee-Womens Hospital in Oakland. The findings show this race-related difference in women who were tracked in the six weeks after giving birth.

Previous research found hypertensive disorders, such as preeclampsia and gestational hypertension, occur in 10%-20% of pregnancies in the United States, said Dr. Alisse Hauspurg, assistant professor at the Pitt School of Medicine and a maternal-fetal medicine specialist at Magee. She is the lead author of a study published in December in the JAMA Network Open medical journal. As part of her research, Hauspurg and Dr. Hyagriv Simhan, executive vice chair of obstetrical services at Magee, helped set up the remote monitoring to collect blood pressure data on 1,077 women who had a hypertensive disorder during pregnancy via a blood pressure monitoring program.

The program provides women with a blood pressure cuff. It prompts them to take their blood pressure, which along with heart rate, are recorded via an app.

According to Magee, participants contributed 17,146 blood pressure readings. Researchers found blood pressure decreases rapidly in the first three weeks after birth and then stabilizes. A substantial proportion of women still have high blood pressure six weeks postpartum.

“Understanding the trajectory of blood pressure decline after a hypertensive disorder of pregnancy might be important to preventing these complications,” Hauspurg said.

Women who experience these disorders often continue to have high blood pressure after delivery, which can increase the risk of seizures, strokes and even maternal death, she said.

Black women have a less rapid decline in blood pressure postpartum, Hauspurg said. And 68% of Black women met criteria for stage 1 or stage 2 hypertension, compared with 51% of white women.

Monitoring blood pressure numbers plays a crucial role in keeping hypertension in check. The top number is the systolic blood pressure and indicates how much pressure a person’s blood is exerting against artery walls when the heart beats. The bottom is the diastolic blood pressure, which indicates how much pressure one’s blood is exerting against artery walls while the heart is resting between beats, according to the American Heart Association.

A normal blood pressure reading is 120/80.

“It is so important to know the facts and for women to advocate for themselves from their prenatal care to the delivery room to after the baby is born,” Kelly said. “This is a real concern because so many things that can (happen) happened to me before, during and after childbirth. I could have died.”

Kelly said she had never heard this could happen. She recommends telling the doctor how you are feeling and wants to shed light on this topic. The experience has her concerned about trying to have another baby.

The first few days after her son’s birth, on a Friday, she felt fatigued. She attributed that to not sleeping or eating much.

By Wednesday, she was nauseous, vomiting and had diarrhea.

“I thought I might have covid,” she said. “So I called the midwives to see if (gastrointestinal) related issues were a sign of covid. I still wasn’t feeling well so that is when I checked my blood pressure.”

A blood pressure cuff is given to pregnant Magee patients because many appointments are now virtual.

“I am feeling much better,” Kelly said Thursday. “I check my blood pressure based on how I feel.”

Simhan and Hauspurg are interested in future studies that look at the blood pressure trajectories for a longer time period. Simhan said it’s critical they catch a potential crisis before the woman ends up in the emergency room.