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

摘要 在美国，严重的孕产妇发病率和死亡率不断上升。 黑人妇女的负担过重。黑人女性比白色女性多3到4倍 妇女在怀孕期间或之后患上或死于并发症。高血压疾病 妊娠（HDP）（例如，先兆子痫，妊娠高血压）是严重的 产妇发病率和死亡率以及长期心血管疾病（CVD）。黑色 妇女比白色妇女更有可能患有严重形式的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证据 记录产后血压恢复情况的种族差异的数据， 分娩后6周和12个月时患有HDP的女性。尽管总体呈下降趋势， HDP妇女的产后血压，黑人妇女的血压更高， 在6周时，更有可能患有2期高血压（≥140/90 mmHg） 产后与白色妇女相比（32.4%对18.2%，p <0.001）;趋势持续到1 交付后一年。我们建议减少血压控制的种族差异， 利用我们医院发起的6周家庭采血， 压力监测计划（HBPM）的妇女与HDP和我们的新的社区合作伙伴 多层次的干预与健康的开始公司。我们的目标是：1）测试增强护理干预 策略（6周HBPM，产后导乐教育和支持，12个月无线 HBPM和体重监测）与常规护理对照（6周HBPM）相比， HDP女性的血压特征; 2）确定加强护理策略是否会 消除BP档案中的种族差异，3）确定获得和提供公平的 临床护理对于所有女性在一年内成功从HDP中恢复至关重要 产后我们假设，加强护理干预植根于健康公平 框架将改善HDP妇女的产后血压恢复状况 并将在一年后缩小黑人和白色女性之间的血压差距 交付.我们的方法是进行一项平行的两组试验，随机选择454名妇女 HDP患者（75%黑人，25%白色）接受常规护理或加强护理干预，以改善 产后一年内血压控制。改善血压控制至关重要， 预防进展为慢性高血压，减少高血压的种族差异， 全面改善妇女健康。

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.