Eliminating racial disparities in severe maternal morbidity by addressing hypertension in the year after delivery

摘要 美国严重孕产妇发病率和死亡率的上升。 给黑人女性带来了不成比例的负担。黑人女性比白人女性的可能性高3到4倍 妇女在怀孕期间或怀孕后遭受并发症或死于并发症。高血压病 妊娠(HDP)(例如，先兆子痫、妊娠期高血压)是严重 产妇发病率和死亡率以及长期心血管疾病(CVD)。黑色 女性比白人女性更容易患上严重形式的HDP和严重的产后 慢性高血压、中风和心血管疾病等并发症。我们有令人信服的初步结果 记录以下人群产后血压恢复情况的种族差异的数据 孕妇在产后6周和12个月发生HDP。尽管#年总体呈下降趋势 在患有HDP的妇女中，黑人妇女的产后血压较高 血压和更有可能在6周时出现二期高血压(≥140/90毫米汞柱) 产后对比白人女性(32.4%vs.18.2%，p&lt；0.001)； 交货后一年。我们建议将血压控制方面的种族差异缩小到 利用我们医院发起的6周家庭血液对HDP妇女产后一年的影响 针对患有HDP的女性的压力监测计划(HBPM)和我们新的社区合作伙伴 与Healthy Start Inc.进行多层次干预。我们的目标是：1)测试增强型护理干预 策略(6周HBPM、产后助产士教育和支持、12个月无线 HBPM和体重监测)与常规护理对照(HBPM 6周)进行比较，以改善 患有HDP的妇女的血压状况；2)确定加强护理策略是否将 消除BP档案中的种族差异，以及3)确定获得和交付公平的 对所有女性在一年内成功康复至关重要的临床护理 产后。我们假设，加强保健干预植根于健康公平 框架将改善HDP女性产后血压恢复情况 并将在第二年缩小黑人和白人女性之间的血压差距 送货。我们的方法将是进行一项平行的双臂试验，随机选择454名女性 将HDP(75%黑人，25%白人)纳入常规护理或加强护理干预以改善 产后一年内控制血压。改善血压控制对以下方面至关重要 防止进展为慢性高血压，减少高血压的种族差异，以及 全面提高妇女健康水平。

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.