Maternal mortality has recently increased in the United States with over 700 women dying annually from pregnancy-related complications. Approximately 60 percent of these deaths are preventable. Hypertensive disorders of pregnancy, including preeclampsia, gestational hypertension, and postpartum hypertension, have been identified as a major cause of maternal morbidity and mortality and disproportionately affecting racial/ethnic minorities. Indeed, social determinants of health such as poverty, lower education, race/ethnic status, lack of a partner, racism, stress, and lack of access to health care (including mental health) are critical risk factors for maternal mortality and morbidity and drive inequities in health outcomes.
Priority populations who have been historically underserved and experience persistent systemic racism and resulting inequities are at increased risk of suboptimal maternal outcomes. This project’s primary project goal is to improve clinical outcomes, including mental health outcomes, among postpartum at-risk women experiencing health disparities by increasing awareness, detection, and timely care of postpartum hypertension, mental health, and cardiovascular complications.
This project will compare the effectiveness of two multicomponent, multilevel healthcare delivery models focused on early detection and control of postpartum hypertension and the social and mental health factors known to impact maternal outcomes with the current standard of care and with each other.
The project will enroll priority populations in three medical centers using an intervention study design, comparing standard of care (SoC) for postpartum participants with: 1) a Remote Medical Model (RMM) which includes SoC plus remote home blood pressure monitoring and treatment, weekly virtual visits for six weeks by a physician extender (e.g., nurse practitioner, pharmacist, etc.), and screening for social determinants of health (e.g., poor housing and food insecurity) and anxiety/depression with referral for services if positive and 2) a Community Health Model which includes SoC, RMM, plus the utilization of community health workers trained in a strength-based trauma approach.
The project aims to improve mean postpartum systolic blood pressure at six weeks and reduce depression severity at three months postpartum.