Optimizing Cardiovascular Preventive Care for Women following Hypertensive Disorders of Pregnancy.

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PROJECT SUMMARY/ABSTRACT This is a K23 proposal for Dr. Lauren Theilen, a Maternal-Fetal Medicine physician with expertise in long-term maternal health following hypertensive disorders of pregnancy. In order to investigate strategies for improved cardiovascular (CV) health among women following complicated pregnancy, this K23 will allow Dr. Theilen to acquire critical skills in four career development areas: 1) qualitative and mixed methods research approaches; 2) development and refinement of a patient decision aid; 3) design and conduct of clinical trials; and 4) research leadership and management skills. To achieve her goals, Dr. Theilen has assembled an interdisciplinary mentoring team comprised of Dr. Michael Varner (Primary Mentor), a senior investigator and recognized leader in perinatal clinical trials, and three Co-Mentors: Dr. Bob Silver, an accomplished researcher in the field of pregnancy as a window to future health, Dr. Susan Zickmund, an expert in qualitative and mixed methods research, and Dr. Elissa Ozanne, a leading investigator in patient risk communication and decision aid development. Complementing this mentoring team, Dr. Theilen also has a 3-member advisory committee to support her proposed decision aid development and pilot trial. Current evidence demonstrates that women with hypertensive disorders of pregnancy have 2-fold higher risk for the later development of CV disease (CVD) compared to women with healthy pregnancies. CVD prevention is a high priority for women’s health, as it is the leading cause of death among women in the United States. In order to improve women’s CV health, interventions for CV prevention could be initiated shortly after a pregnancy complicated by a hypertensive disorder. However, few researchers are trained in developing patient-centered interventions to promote preventive care engagement among postpartum women. Dr. Theilen’s objective is to address current gaps in knowledge regarding needs, values, and barriers regarding CVD prevention among postpartum women with hypertensive disorders of pregnancy, and to remedy the lack of available evidence-based interventions for this at-risk population. She proposes the following Specific Aims: Aim 1) Determine information needs, values, and barriers influencing CV risk communication and engagement among postpartum women and their obstetric and primary care providers; Aim 2) Develop a decision aid to improve patient CV risk knowledge and preventive health engagement for postpartum women with hypertensive disorders of pregnancy; and Aim 3) Conduct a pilot study to demonstrate feasibility and preliminary efficacy of a patient decision aid to improve patient knowledge and self-efficacy regarding CVD prevention during the postpartum period. The proposed research is significant because it investigates a strategy to reduce the CVD burden among women with hypertensive disorders of pregnancy. This proposal is innovative because it comprises a substantial departure from the existing postpartum clinical care paradigm in the United States.