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Hypertensive Disorders of Pregnancy and Maternal-Fetal Outcomes Among African Women: A Systematic Review
Abstract   Peer reviewed

Hypertensive Disorders of Pregnancy and Maternal-Fetal Outcomes Among African Women: A Systematic Review

Dennis Miezah, Eunice Asare, Nuheila Ibrahim, Eric Peprah, Rockson Ansong, Esther Gordon, Raymond Akorlatse, Musah Abubakri, Richard Marfo and Thomas Hinneh
Nursing research (New York), v 75(3), pp E173-E173
May 2026
DOI: https://doi.org/10.1097/NNR.0000000000000903#page=E173

Abstract

leading cause of preventable maternal morbidity and mortality in the United States. Because blood pressure (BP) peaks after discharge, guidelines recommend evaluation within 7-10 days postpartum for individuals with HDP. Fewer than half receive this follow-up, with the lowest rates among Black and Hispanic patients, who face the highest risk of severe complications. Understanding multilevel factors driving this gap is essential to advancing equity in postpartum care and outcomes, and was the focus of this integrative review. Theoretical Framework: Intersectionality guided this review to examine how racism, classism, and structural disadvantage shape postpartum care engagement among individuals with HDP. This framework centers the interactions among systems of power and identity—not just individual factors—but examining how social and structural conditions jointly influence postpartum follow-up. Methods: Using Whittemore and Knafl’s integrative review approach, PubMed, CINAHL, Scopus, and Web of Science were searched for studies published May 2018-February 2025, reflecting the period after American College of Obstetricians and Gynecologists’ 2018 guidelines recommending early postpartum BP evaluation for individuals with HDP. Eligible U.S.-based quantitative, qualitative, or mixed-methods studies examining BP follow-up within 10 days postpartum after HDP were included; case reports and studies without racial or ethnic data were excluded. Thirteen studies met criteria, were appraised using the Johns Hopkins Evidence-Based Practice model, and synthesized thematically to identify multilevel barriers, facilitators, and predictors of follow- up. Results: Barriers included structural racism, inadequate insurance, limited care access, and digital exclusion. Facilitators included remote BP monitoring, nurse-led interventions, and supportive provider communication. Predictors such as younger age, multiparity, and less severe HDP were associated with lower follow-up, identifying patients who may benefit from additional outreach. Conclusions and Implications: Disparities in early postpartum BP follow-up are rooted in intersecting social and structural inequities. These findings align with prior research demonstrating the benefits of remote BP monitoring but extend the evidence by identifying populations who remain excluded. Equity-driven strategies, such as remote BP monitoring integrated within relationship-centered care models that address social determinants, are essential to improving postpartum outcomes and reducing disparities. Future research should evaluate how these strategies can be implemented to overcome structural barriers and engage populations most affected by HDP.

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