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Principal Investigator: Janet M Catov
Organization: MAGEE-WOMEN'S RES INST AND FOUNDATION
Fiscal Year: 2024
Award: $551,784
Funding agency: National Institute on Minority Health and Health Disparities
ABSTRACT
The increasing rate of severe maternal morbidity and mortality events in the U.S.
disproportionately burdens Black women. Black women are 3 to 4 times more likely than white
women to suffer or die from complications during or after pregnancy. Hypertensive disorders of
pregnancy (HDP) (e.g., preeclampsia, gestational hypertension) are major contributors to severe
maternal morbidity and mortality, as well as long-term cardiovascular disease (CVD). Black
women are more likely than white women to have severe forms of HDP and severe post-partum
complications such as chronic hypertension, stroke and CVD. We have compelling preliminary
data that documents racial disparities in the post-partum blood pressure recovery profile among
women with HDP at 6 weeks and 12 months after delivery. Despite an overall downward trend in
post-partum blood pressures among women with HDP, Black women have higher blood
pressures and are more likely to have stage 2 hypertension (≥140/90 mmHg) at 6 weeks
postpartum compared to white women (32.4% versus.18.2%, p <0.001); trends that persist to one
year after delivery. We propose to decrease the racial disparity in blood pressure control at one
year postpartum among women with HDP by leveraging our hospital-initiated 6-week home blood
pressure monitoring program (HBPM) for women with HDP and our novel community-partnered
multi-level intervention with Healthy Start Inc. We aim to: 1) test an enhanced care intervention
strategy (6 weeks of HBPM, postpartum doula education and support, 12 months of wireless
HBPM and weight monitoring) compared to usual care control (6 weeks of HBPM) to improve the
blood pressure profile among women with HDP; 2) determine if an enhanced care strategy will
eliminate racial disparities in BP profiles, and 3) determine the access to and delivery of equitable
clinical care that is essential for all women to successfully recover from HDP within one year
postpartum. We hypothesize that the enhanced care intervention rooted within a health equity
framework will improve the post-partum blood pressure recovery profile among women with HDP
and will close the blood pressure disparity between Black and White women in the year after
delivery. Our approach will be to conduct a parallel, two-arm trial that randomizes 454 women
with HDP (75% Black, 25% White) into usual care or an enhanced care intervention to improve
blood pressure control in the year after delivery. Improving blood pressure control is essential to
prevent progression to chronic hypertension, reduce racial disparities in hypertension, and
improve women’s health overall.
Terms: <2-arm trial><Address><Adherence><Adverse Experience><Adverse event><Affect><Apoplexy><BP control><BP management><Biometrics><Biometry><Biostatistics><Black><Black race><Blood Pressure><Blood Pressure Monitors><Brain Vascular Accident><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cardiac Diseases><Cardiac Disorders><Cardiac health><Cardiovascular Diseases><Caring><Caucasian Females><Caucasian Women><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Cessation of life><Chronic><Clinical><Clinical Trials><Communities><Continuous Sphygmomanometers><Coupled><Data><Death><Discipline of obstetrics><Disease><Disorder><Disparities><Disparity><EPH Gestosis><Education><Educational aspects><Enrollment><Ensure><Epidemiology><Equity><Event><Family Practice><Female Health><Gestation><Gestational Hypertension><Guidelines><Health><Health Care Professional><Health Inequity><Health Professional><Healthcare professional><Heart Diseases><Heart failure><Heart health><Home Blood Pressure Monitoring><Home visitation><Hospitals><House Call><Hypertension><Hypertension induced by pregnancy><Hypertension-Associated Pregnancy Disorder><Incidence><Inequalities in Health><Inequities in Health><Inequity><Intervention><Intervention Strategies><Knowledge><Life Style><Lifestyle><Maternal Mortality><Maternal and Child Health><Measurement><Mission><Monitor><Mothers><NCMHD><NIMHD><National Center on Minority Health and Health Disparities><National Institute of Minority Health and Health Disparities><National Institute on Minority Health and Health Disparities><Obstetrics><Outcome><Patients><Population><Postpartum Period><Pre-Eclampsia><Preeclampsia><Pregnancy><Pregnancy Associated Hypertension><Pregnancy Toxemias><Proteinuria-Edema-Hypertension Gestosis><Psychiatry><Race><Races><Randomization trial><Recovery><Research><Risk><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Self Blood Pressure Monitoring><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Single-Blind Study><Single-blind><Site><Stroke><System><Testing><Time><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Weight><White Females><White Women><Woman><Women's Health><after pregnancy><black female><black women><blood pressure control><blood pressure management><brain attack><cardiac failure><cardiovascular disorder><care as usual><cerebral vascular accident><cerebrovascular accident><clinical applicability><clinical application><clinical care><community engaged approach><community engaged approaches><community engaged strategies><community engaged strategy><community engagement><community factor><community partnered approach><community partnered strategy><community partners><community partnership><community-based partners><community-level factor><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><differences due to race><differences in health><differences in race><differs by race><differs in race><disparities in race><disparity due to race><disparity in care><disparity in healthcare><engagement with communities><enhanced care><enroll><epidemiologic><epidemiological><evidence base><experience><family medicine><feasibility trial><health care disparity><health care inequality><health care inequity><health care service><health difference><health equity><health inequalities><healthcare disparity><healthcare inequality><healthcare inequity><healthcare service><heart disorder><high blood pressure><high risk><home visit><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disease of pregnancy><hypertensive disorder><improved><inequality due to race><inequity due to race><innovate><innovation><innovative><interventional strategy><maternal death><maternal morbidity><mortality><multidisciplinary><novel><post pregnancy><post-partum><post-partum complications><postpartum complications><pre-eclamptic><pregnancy disorder><pregnancy hypertension><pregnancy toxemia/hypertension><pressure><prevent><preventing><programs><race based differences><race based disparity><race based inequality><race based inequity><race differences><race disparity><race related differences><race related disparity><race related inequality><race related inequity><racial><racial background><racial difference><racial disparity><racial inequality><racial inequity><racial minority group><racial minority individual><racial minority people><racial minority population><racial origin><racially different><racially unequal><randomized trial><recruit><service delivery><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><severe maternal morbidity><social media><socio-economic><socio-economically><socioeconomically><socioeconomics><stroked><strokes><treatment as usual><trend><trial comparing><two-arm trial><usual care><virtual intervention><weights><wireless>