Postpartum hospital readmissions are increasing over time, though they remain lower than medical or surgical readmissions [1]. Readmissions highlight a population that is potentially at greater risk for severe maternal morbidity during the postpartum period [2], [3], [4]. They create considerable costs for the healthcare system [4], [5] and may disrupt the maternal-neonatal dyad during a critical period for bonding and initiation of breastfeeding. Understanding the factors driving postpartum readmissions may help to optimize postpartum care [6].Fig 1.

Hypertensive disorders of pregnancy (HDP) occur in approximately 10 percent of pregnancies. Existing studies estimate that between 9.3 percent and 21.5 percent of postpartum readmissions occur due to HDP [1], [7]. Between 2013 and 2014, postpartum readmissions for HDP cost the healthcare system approximately $731 million and required 404,000 additional days in inpatient hospital care [8]. Aside from postpartum readmissions for hypertension, individuals with HDP have demonstrated increased risk for postpartum readmissions for all causes [1], [9].

Previous studies have extensively examined risk factors for postpartum readmission for hypertension such as clinical factors or, rarely, social determinants of health. New guidelines were published in 2013 which changed the definitions of HDP as well as recommendations regarding its clinical management. Limited work has examined whether decisions made during the delivery admission – for example, administration of oral diuretics [10] – influence postpartum readmission for hypertension among people with HDP, but studies have not accounted for changes in clinical guidelines regarding HDP.

Thus, we aimed to investigate trends in postpartum readmissions and the clinical management of HDP over time among individuals with HDP with and without severe features, as defined by American College of Obstetricians and Gynecologists (ACOG) criteria. Examining the impact of clinical decisions during delivery admission for individuals with HDP on postpartum readmissions may provide future directions for research and quality improvement efforts focused on the postpartum care paradigm for this population.