Factors Associated With Missed Early Postpartum Blood Pressure Follow-Up and Subsequent Routine Postpartum Visit Attendance.

Background Early postpartum blood pressure follow-up is recommended for individuals with hypertensive disorders of pregnancy, yet attendance remains inconsistent. This study evaluated factors associated with missed postpartum day-10 blood pressure follow-up and compared subsequent attendance at routine postpartum visits between individuals who missed the day-10 assessment and those who completed it. Methods This retrospective cohort included individuals with hypertensive disorders of pregnancy who delivered at an urban safety-net health system between April 2025 and April 2026. The primary outcome was missed postpartum day-10 blood pressure follow-up. Demographic, obstetric, medical, treatment, and follow-up variables were obtained from the electronic medical record. Multivariable logistic regression was used to identify factors associated with missed follow-up. Results Of 201 individuals identified, 189 were included in the final cohort; 110 (58.2%) missed postpartum day-10 blood pressure follow-up, and 79 (41.8%) completed it. Severe hypertensive disorder of pregnancy was associated with lower odds of missing postpartum day-10 follow-up (adjusted odds ratio: 0.38, 95% confidence interval: 0.18-0.79; p=0.009). Vaginal delivery (adjusted odds ratio: 1.90, 95% confidence interval: 1.01-3.58; p=0.047) and psychiatric disorder (adjusted odds ratio: 3.73, 95% confidence interval: 1.14-12.25; p=0.030) were associated with higher odds of missing the day-10 blood pressure assessment. Maternal age, body mass index, and discharge on antihypertensive medication were not significantly associated with the outcome. Overall, 142 individuals (75.1%) completed the routine postpartum visit. Attendance was lower among individuals who missed postpartum day-10 blood pressure follow-up than among those who completed it (64.5% vs. 89.9%; p<0.001). Conclusions Missed postpartum day-10 blood pressure follow-up occurred in more than half of the cohort. Severe hypertensive disease was associated with lower odds of missed follow-up, whereas vaginal delivery and psychiatric disorder were associated with higher odds. Most individuals who missed the day-10 assessment still completed the routine postpartum visit, suggesting that missed early surveillance may reflect gaps in the timing or structure of early follow-up rather than complete disengagement from postpartum care. These findings support the evaluation of targeted strategies, including enhanced discharge counseling, reminder systems, and flexible options for blood pressure surveillance, to improve completion of early postpartum follow-up.