Perinatal Research Collective

Hypertensive disorders of pregnancy (HDP) impact 15% of U.S. pregnancies and are linked to significantly elevated long-term cardiovascular risks, particularly among underserved populations[1],[2],[3],[4],[5],[6]. This initiative seeks to improve maternal health outcomes by collaborating with individuals with lived experience to co-lead research, shape implementation strategies, guide dissemination efforts, and support mentorship for emerging investigators.

Funder(s):

Fully funded by the Health Resources and Services Administration (HRSA)

See: Opportunity Listing - Maternal and Child Health Research Consortium (MCH RC)

Funding Amount: $2,064,680

Project Duration: 3 years

Project Collaborators at UPMC: UPMC Center for High-Value Health Care; UPMC Women’s Health Service Line; University of Pittsburgh, Preeclampsia Foundation

Research Location: UPMC Center for High-Value Health Care; UPMC Women’s Health Service Line

Background:

Hypertensive disorders of pregnancy (HDP), including preeclampsia, gestational hypertension, and chronic hypertension can occur in 15% of US pregnancies, and its incidence continues to rise[1]. HDP are a leading cause of maternal death and lifetime risk of cardiovascular disease (CVD) is 2-4 times higher among individuals with HDP compared to those without HDP[2],[3]. Patient subgroups, including those residing in rural regions, individuals with low-income or who are insured through Medicaid, and minoritized populations are more likely to experience negative HDP outcomes[4],[5],[6].

Healthcare challenge:

The American College of Obstetricians and Gynecologists (ACOG), the American Heart Association, and other professional organizations have developed clinical guidelines to support short-term management of HDP and long-term monitoring of CVD-related risks after HDP[7],[8]. Despite this, engagement in recommended care protocols remains inconsistent. Further, many care models fail to reflect the lived realities of patients or the unique needs of diverse communities. There is a pressing need for evidence on how to best deliver coordinated, patient-centered, and equity-focused care in these populations and settings.

Goals:

We will conduct a series of studies to improve outcomes for individuals with hypertensive disorders of pregnancy (HDP), with a focus on care navigation to promote engagement in essential HDP treatment and monitoring during the first postpartum year. We will also complete a feasibility study to evaluate and optimize the use of patient incentives to increase participation in key postpartum care activities, including remote blood pressure monitoring, postpartum visits, recommended laboratory testing, and primary care follow up. Although incentive-based interventions have been effective in other clinical populations, they have not been studied in perinatal patients with HDP. In addition, we will provide mentorship opportunities for early career investigators in maternal and child health research.

Implementation Approach:

Target populations: Perinatal individuals receiving care at UPMC facilities who have experienced HDP and the providers who care for them.

Methodology: 

This project will use a series of stakeholder engagement strategies and research methods to design and evaluate the impact of the care navigation and incentive-based interventions. Implementation and evaluation approaches include:
  • Conducting interviews and human-centered design sessions to co-develop the interventions and related workflows with patients, providers, and other key stakeholders.
  • Evaluating the impact of the intervention on engagement in guideline-based care using self-report survey and electronic health record data.
  • Conducting semi-structured interviews to examine barriers and facilitators related to intervention implementation, engagement, adoption, and sustainability.

This work is supported by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), U.S. Department of Health and Human Services (HHS) under grant number U0AMC54982. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, HRSA, MCHB, HHS, or the U.S. Government.

Cited references

[1] Ford ND, Cox S, Ko JY, et al. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization - United States, 2017-2019. MMWR Morb Mortal Wkly Rep. Apr29 2022;71(17):585-591.

[2] Lo CCW, Lo ACQ, Leow SH, et al. Future Cardiovascular Disease Risk for Women With Gestational Hypertension: A Systematic Review and Meta-Analysis. J Am Heart Assoc. Jul 7 2020;9(13):e013991.

[3] Visser VS, Hermes W, Franx A, et al. High blood pressure six weeks postpartum after hypertensive pregnancy disorders at term is associated with chronic hypertension. Pregnancy Hypertens. Oct 2013;3(4):242-7.

[4] Greiner KS, Speranza RJ, Rincón M, Beeraka SS, Burwick RM. Association between insurance type and pregnancy outcomes in women diagnosed with hypertensive disorders of pregnancy. J Matern Fetal Neonatal Med. Apr 2020;33(8):1427-1433.

[5] Francis B, Pearl M, Colen C, Shoben A, Sealy-Jefferson S. Racial and Economic Segregation Over the Life Course and Incident Hypertensive Disorders of Pregnancy Among Black Women in California. Am J Epidemiol. Feb 5 2024;193(2):277-284.

[6] Hauspurg A, Bryan S, Jeyabalan A, et al. Blood Pressure Trajectories Through the First Year Postpartum in Overweight or Obese Individuals Following a Hypertensive Disorder of Pregnancy. Hypertension. Feb 2024;81(2):302-310.

[7] ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstet Gynecol. May2018;131(5):e140-e150.

[8] Ackerman-Banks CM, Grechukhina O, Spatz E, et al. Seizing the Window of Opportunity Within 1 Year Postpartum: Early Cardiovascular Screening. J Am Heart Assoc. Apr 192022;11(8):e024443.