Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Dec 10, 2025
Date Accepted: Mar 20, 2026
Association Between Gestational Blood Pressure Trajectories and Postpartum Normotension Recovery in Hypertensive Disorders: A Retrospective Cohort Study
ABSTRACT
Background:
Hypertensive disorders of pregnancy may cause lasting vascular, cardiac, and renal damage, potentially increasing the risk of postpartum cardiovascular disease.
Objective:
This study examined the association between gestational blood pressure trajectories in different subtypes of hypertensive disorders of pregnancy and the risk of unrecovered blood pressure at 6 weeks postpartum to enable early identification of pregnant women at high risk of poor postpartum blood pressure recovery.
Methods:
3162 women with HDP were obtained from the antenatal care and the postpartum follow-up information system, and the birth registration system, between January 1, 2018, and December 31, 2024. Group-based trajectory modeling was used to fit systolic blood pressure, diastolic blood pressure, and mean arterial pressure trajectories during pregnancy. Modified Poisson regression was employed to assess the association between gestational blood pressure trajectories and the risk of unrecovered blood pressure at 6 weeks postpartum.
Results:
Trajectories of systolic blood pressure, diastolic blood pressure, and mean arterial pressure during pregnancy were significantly associated with unrecovered blood pressure at 6 weeks postpartum in women with gestational hypertension, chronic hypertension with superimposed preeclampsia, and chronic hypertension (P<0.05). Among women with preeclampsia, only systolic blood pressure trajectory was significantly associated with unrecovered blood pressure postpartum (P<0.05). The high-consistent rise and high-late surge trajectories of systolic blood pressure, diastolic blood pressure, and mean arterial pressure in gestational hypertension started at similar initial levels and crossed at approximately 22 weeks of gestation.
Conclusions:
The gestational blood pressure trajectories in women with hypertensive disorders of pregnancy are positively associated with the risk of unrecovered blood pressure at 6 weeks postpartum. Early identification of women at high risk for poor postpartum blood pressure recovery through blood pressure trajectory analysis may have important clinical implications for improving long-term cardiovascular outcomes in this population. Clinical Trial: N/A
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