LAUSR

OBJECTIVE Postpartum preeclampsia, defined as de novo preeclampsia that develops at least 48 hours following delivery, can be particularly dangerous as many patients are already discharged at that point. The goal of our study was to identify risk factors uniquely associated with the development of late postpartum preeclampsia. STUDY DESIGN In a retrospective cohort study of deliveries between July 1, 2016 and June 30, 2018 at a safety-net hospital in Atlanta, Georgia, we used multinomial logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between demographic, medical, and obstetric factors and development of preeclampsia, categorized as a 3-level outcome: no preeclampsia, antepartum/intrapartum preeclampsia (diagnosed prior to or < 48 hours of delivery), and late postpartum preeclampsia (diagnosed ≥ 48 hours postpartum). RESULTS Among 3,681 deliveries, women were primarily ages 20-35 (76.4%), identified as non-Hispanic Black (68.5%), and covered by public health insurance (88.6%). Preeclampsia was diagnosed prior to delivery or within 48 hours postpartum in 12% (n=477) of the study population, and 1.5% (57) developed preeclampsia greater than 48 hours postpartum. In the adjusted models, maternal age ≥ 35, race/ethnicity, nulliparity, a diagnosis of pre-gestational or gestational diabetes, and chronic hypertension were associated with increased odds of antepartum preeclampsia only, while maternal obesity (OR 1.9, 95% CI 1.0-3.5) and gestational hypertension (OR 2.7, 95% CI 1.5-4.8) were uniquely associated with postpartum preeclampsia. Multifetal gestations and Cesarean delivery predicted both postpartum and antepartum/intrapartum preeclampsia, however the association was stronger for postpartum preeclampsia. CONCLUSION Patients with obesity, gestational hypertension, multifetal gestations, or Cesarean delivery may benefit from additional follow-up in the early postpartum period to detect postpartum preeclampsia.