In the United States, people giving birth face high rates of serious health problems. One of the major causes is problems with high blood pressure, known as hypertensive disorders of pregnancy (HDP). HDP affects one in seven birthing people. The risk is even higher for Black people, who are more likely than White people to develop this condition and to get very sick, or even die.
To make pregnancy and birth safer in North Carolina, local health departments in 10 counties came together with families, community groups and researchers to plan the Thriving Hearts study. The study’s goal is to ensure people not only survive pregnancy, but they thrive. The study team aims to make a difference for individual patients, healthcare teams and communities in the following ways:
- For individual patients, the team will work with prenatal clinics to help people know if they are at high risk for HDP. People at high risk will get a Mama Hearts Care Kit. The kit will have tips about checking blood pressure, a home blood pressure monitor and a bottle of low-dose aspirin, a medicine that can prevent HDP. People at high risk can also sign up for free Mama Hearts text messages with blood pressure reminders and health tips.
- For healthcare teams, the study will offer workshops on healing-centered, trauma-informed care. Many healthcare workers are burned out from the COVID-19 pandemic, and they need support to heal so that they can take good care of themselves and their patients.
- For communities, community health workers will lead with resources, reaching out to connect pregnant people with community events and resources. The study will offer mini grants for local community groups to create spaces for support, connection and joy. If people need help, Thriving Heart includes a Medical Legal Partnership, which can help solve problems with things like unsafe housing.
To see how well the Thriving Hearts program works, researchers will conduct a five-year study. At the start of the study, none of the 10 counties will have the program. Researchers will determine what each county is already offering pregnant and postpartum people. Every nine months, two counties will begin offering Thriving Hearts, until all 10 counties have the program. Researchers will track what happens to everyone in the 10 counties who has a baby—about 140,000 people over the five-year study—before and after the Thriving Hearts program begins.
This study has four goals:
- Measure how well Thriving Hearts prevents HDP. Reserachers will use hospital records, insurance claims and birth certificates to track how many people get HDP.
- Measure how Thriving Hearts affects health, well-being and care. About three months after people give birth, the study team will reach out to survey some of them about their experiences. During the five-year study, researchers will survey about 10,000 people.
- Measure how well trauma-informed care helps healthcare workers feel less burned out. Researchers will survey healthcare workers over the course of the study to see if they are doing better after their county has the Thriving Hearts program.
- Find out what makes it easy for counties to offer Thriving Hearts, and what makes it hard. Researchers will talk with patients, community groups and health team members and use what is learned to help other counties start up the Thriving Hearts program.
The study’s primary outcome is HDP. Researchers also will measure how Thriving Hearts changes people’s health care, health outcomes and experience of care and how they are feeling.
The study’s goal is for Thriving Hearts to help community advocates, health system leaders and policy makers understand what types of support matter to growing families. To make sure this is done well, the study team includes people with lived experience of HDP, as well as local health department staff, doulas, lactation counselors, community health workers, dieticians, social workers, nurses, midwives, doctors and researchers.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.