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

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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.