Primary and secondary adherence to antihypertensive medications during pregnancy and postpartum
Bibliographic record
Abstract
• Adherence to antihypertensive medications during pregnancy and postpartum has not been comprehensively studied. • In this electronic health records study, 72.6% patients had primary adherence during pregnancy and 73.4% during postpartum. • Secondary adherence during pregnancy was 63.6% among those with pre-existing hypertension. • Patient and healthcare provider race, blood pressure, obesity, insurance type, and parity were associated with adherence. To examine adherence to antihypertensive medications during pregnancy and postpartum among patients with hypertensive disorders of pregnancy (HDP).. Using electronic health records and healthcare claims data, we examined prenatal care patients aged 16–49 years from a health care system in Minnesota who delivered between 2009–2021, had continuous medical and pharmacy insurance coverage throughout pregnancy and up to 6 weeks postpartum, and had HDP (pre-existing/gestational hypertension, preeclampsia, HELLP syndrome, and eclampsia). Primary outcome was primary adherence to antihypertensives during pregnancy and up to 6 weeks postpartum, separately, defined as filling of first outpatient prescription within 7 days. Secondary outcome was secondary adherence during pregnancy among patients with pre-existing hypertension, defined as proportion of days covered, calculated using prescription fill data. We estimated risk ratios (RR) and 95 % confidence intervals (CIs) to assess associations between patient characteristics and adherence. Among 4,647 eligible patients, 526 (11.3%) and 987 (21.2%) had an outpatient antihypertensive prescription during pregnancy and postpartum, respectively. Primary adherence was observed for 72.6% patients during pregnancy and 73.4% during postpartum. Patients with Black versus White healthcare provider at their first prenatal visit were more likely to have primary adherence during pregnancy (RR 1.22, 95% CI 1.03–1.46) while severe blood pressure was associated with adherence during postpartum (RR 1.26, 95% CI 1.14–1.40). Secondary adherence during pregnancy was 63.6%. Patient race, obesity, health insurance type, and parity were associated with secondary adherence. Approximately 70% of eligible patients had primary adherence but secondary adherence was lower for antihypertensive treatment during pregnancy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".