The Duke Endowment has awarded $650,000 to epidemiology professor Jihong Liu to continue developing a new program designed to protect the health of pregnant and postpartum women in South Carolina. The research team will use this grant to overcome limitations to the standard practice for monitoring postpartum blood pressure (i.e., in person) by offering remote blood pressure monitoring and incorporating coaching from trained community health workers.
Approximately 10-20% of pregnancies are impacted by high blood pressure (i.e., hypertensive) disorders, such as gestational hypertension, preeclampsia, and eclampsia. Of these women, 50% of them go on to develop chronic hypertension after giving birth, despite having typical blood pressure rates prior to pregnancy. All of these disorders, which are increasing in frequency in the U.S., have been associated with long-term cardiovascular disease, with Black women more likely to be diagnosed with high blood pressure earlier in life and suffer higher rates of hypertensive disorders, related hospital readmissions and subsequent cardiac disease.
“The American College of Obstetricians and Gynecologists currently recommends blood pressure monitoring for women who have hypertensive disorders of pregnancy at 72 hours postpartum and then again at 7-10 days to prevent the risk of stroke and seizure,” Liu says. “Unfortunately, approximately 70% of patients do not return to their clinics for these follow-up visits.”
Barriers such as transportation and limited access to childcare and maternity care mean that many women – particularly those in low-resource communities – face challenges in attending these in-person appointments. This has prompted obstetric programs to begin offering remote blood pressure monitoring in recent years.
To assess the effectiveness of this approach, epidemiology associate professor Nansi Boghossian launched a project in 2023 (also funded by The Duke Endowment) to offer at-home blood pressure monitoring to at-risk patients in the Midlands for the first time. Partnering with Prisma Health, the team has already enrolled 290 participants.
While the initial results from this and other research are promising (e.g., cost-savings, acceptability/feasibility by patients and clinicians, reductions in disparities), few studies have evaluated the health outcomes of these programs beyond six weeks postpartum. Liu’s HER HEART (Health Engagement & Recovery) study builds on Boghossian’s project by enrolling another 240 diverse patients and extending their at-home blood pressure monitoring to six months and hospital readmissions tracking to 12 months postpartum. They will also assess the effectiveness of adding a community health worker-led lifestyle program to the intervention strategy through a single-blinded randomized controlled trial.
Participants who are randomly assigned to the group with the community health worker coaching and who continue to have high blood pressure at six weeks postpartum will receive four months of health coaching, including one individual counseling session and 12 weekly calls. These interactions will focus on heart-healthy lifestyle behaviors, such as safely resuming physical activity, avoiding tobacco, achieving a healthy weight, and coping with stress. The community health worker will also provide screening and referrals to relevant services. The HER HEART study will collaborate with Prisma Health clinician Dr. Andrew Mather as well as Prisma Health Midlands Healthy Start program, alongside Boghossian and Dr. Berry Campbell as USC co-investigators.
“The increasing rates of pregnancy-related and chronic hypertension in the U.S. over the past three decades are alarming for all stakeholders in maternal health, including patients, providers, hospital administrators, payers, advocates, and public health researchers,” Liu says. “This program is designed to address the critical need of assisting affected women in preventing severe adverse health outcomes such as stroke and seizure in the early postpartum period as well and mitigating their long-term cardiovascular disease risk.”