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Background

Hypertensive disorders of pregnancy (HDP) are increasingly common and have important implications for maternal health, healthcare utilization, and health disparities. There is limited evidence to support best management of postpartum individuals with HDP, including home blood pressure (BP) monitoring (HBPM) and choice of antihypertensive agents. For patients experiencing preeclampsia with severe features, there is robust evidence supporting delivery of the infant and treatment with magnesium sulfate (MgSO4). However, MgSO4 may cause unpleasant side effects and, less commonly, toxicity. Patients receiving MgSO4 require additional monitoring (eg, urinary catheterization) and often have activity restrictions, which impact their postpartum experience. Evidence regarding the optimal (lowest effective) dose and (shortest effective) duration of MgSO4 treatment is needed.

Methods

We searched Medline®, Cochrane, Embase®, CINAHL®, and ClinicalTrials. gov from inception to December 1, 2022. After double screening, we extracted study data and risk of bias assessments into the Systematic Review Data Repository Plus (SRDR+; https://srdrplus. ahrq. gov). We evaluated the strength of evidence (SoE) using standard methods. The protocol was registered in PROSPERO (registration number CRD42022313075).

Results

We found 13 eligible studies (3 randomized controlled trials [RCTs], 2 nonrandomized comparative studies [NRCSs], 8 single-arm studies) evaluating postpartum HBPM, 17 RCTs evaluating pharmacological treatment of postpartum HDP, and 43 studies (41 RCTs and 2 NRCSs) that compared alternative …