Colorado Nurse Family Heart Trial for the ENRICH program

项目总结 心血管疾病(CVD)是美国的主要死亡原因，其影响大得不同 关于种族/族裔少数群体和低收入个人。心血管疾病的风险在生命的早期就开始是不利的 关键时期(胎儿发育、婴儿期和生育期)的暴露会改变健康轨迹。 对于明显的疾病。因此，从怀孕起促进和维持心血管健康(CVH)的努力 对于减少心血管疾病的代际负担至关重要。因应及早干预推动 母亲和儿童的心血管健康申请(丰富RFA)，我们建议利用 两种广泛可用的干预措施可以促进不同、资源不足的孕妇和子女发生CVH： 护士家庭伙伴关系(NFP)和国家糖尿病预防计划(NDPP)。NFP是一次家访 护士从怀孕到产后24个月第一次支持资源不足的母亲的计划 改善产前结果、儿童安全和发育结果以及经济自给自足。NFP是 在全国260个组织提供，包括我们的丹佛健康合作伙伴，他们已经将其交付给&gt；2400 自2000年以来，城市妇女资源不足。虽然NFP解决了一些可能的危害原因 在孕产妇和儿童健康方面，尚未全面处理或评估CVH。因此，我们建议 通过改编自NDPP的以CVH为重点的节目来提高NFP，这是一种为期一年的循证生活方式 促进健康饮食和活动以减少体重、血糖异常和其他心血管疾病风险的干预措施， 自2013年以来，我们已经在丹佛健康中心为1600名不同的、资源不足的成年人提供服务，其中包括340名年轻人 女人。通过利用NFP的独特优势(家庭分娩模式、专业护理支持、 健康的社会决定因素[SDOH])与NDPP(针对CVH推广的循证内容)，a 在ENRICH计划中严格评估的联合干预(NFP-心脏)有很大的改进潜力 资源匮乏人群中的CVH结局。我们的科罗拉多州护士家庭心脏试验将评估NFP-心脏 从10家诊所招募的600名早孕未分娩妇女(及其子女)与常规护理的比较 在一个安全网中，城市医疗系统。NFP-心脏将通过编程促进代际CVH 由家访护士在孕期20周至产后24个月分娩。我们的具体目标是1) 制定当地的NFP-心脏和通用的RICH协议，并进行试点研究，以确认可行性和 可接受性；2)评估NFP-心脏对母子CVH指标的影响；3)评估程度 SDOH修改了NFP-心脏干预对母子CVH结局的影响；以及 4)审查NFP-心脏干预的实施情况和使用混合- 方法：研究方法。

PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death in the United States, with disparately greater impact on racial/ethnic minorities and lower-income individuals. Risk for CVD begins very early in life as adverse exposures during critical periods (fetal development, infancy, and reproductive years) shift the health trajectory toward overt disease. Thus, efforts to promote and maintain cardiovascular health (CVH) from pregnancy onward are crucial to reducing the intergenerational burden of CVD. In response to the Early Intervention to Promote Cardiovascular Health of Mothers and Children request for applications (ENRICH RFA), we propose to leverage two widely-available interventions to promote CVH in diverse, under-resourced pregnant women and offspring: Nurse Family Partnership (NFP) and the National Diabetes Prevention Program (NDPP). NFP is a home visiting program in which nurses support first-time, under-resourced mothers from pregnancy to 24 months postpartum to improve prenatal outcomes, child safety and developmental outcomes, and economic self-sufficiency. NFP is available at >260 organizations nationwide, including our Denver Health partners who have delivered it to >2400 urban, under-resourced women since 2000. While NFP addresses some putative causes of compromised maternal and child health, CVH has not been comprehensively addressed nor evaluated. Thus, we propose to enhance NFP with CVH-focused programming adapted from the NDPP, a yearlong, evidence-based lifestyle intervention that promotes healthy eating and activity to reduce weight, dysglycemia, and other CVD risks, which we have delivered to >1600 diverse, under-resourced adults at Denver Health since 2013, including >340 young women. By leveraging unique strengths of NFP (home delivery model, professional nursing support, impact on social determinants of health [SDOH]) with those of NDPP (evidence-based content for CVH promotion), a combined intervention (NFP-Heart) rigorously evaluated in the ENRICH program has great potential to improve CVH outcomes in under-resourced populations. Our Colorado Nurse Family Heart Trial will evaluate NFP-Heart versus usual care among 600 nulliparous women (and their offspring) recruited in early pregnancy from 10 clinics in a safety-net, urban healthcare system. NFP-Heart will promote intergenerational CVH with programming delivered from 20 weeks gestation to 24 months postpartum by home visiting nurses. Our specific aims are 1) develop the local NFP-Heart and common ENRICH protocols, and conduct pilot studies to confirm feasibility and acceptability; 2) evaluate the effect of NFP-Heart on maternal and offspring CVH metrics; 3) assess the degree to which SDOH modify the effect of the NFP-Heart intervention on maternal and offspring CVH outcomes; and 4) examine the implementation of the NFP-Heart intervention and potential for sustainability using a mixed- methods approach.