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

通过解决产后一年的高血压问题消除严重孕产妇发病率的种族差异

基本信息

批准号：
10693282
负责人：
Janet M Catov
金额：
$ 57.99万
依托单位：
MAGEE-WOMEN'S RES INST AND FOUNDATION
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-30 至 2027-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10693282
关键词：
Address Adherence Adverse event Affect Biometry Black race Blood Pressure Blood Pressure Monitors COVID-19 pandemic Cardiac health Cardiovascular Diseases Caring Cessation of life Chronic Clinical Clinical Trials Communities Coupled Data Discipline of obstetrics Disease Disparity Education Enrollment Ensure Epidemiology Equity Event Family Practice Guidelines Health Health Professional Heart Diseases Heart failure Home Blood Pressure Monitoring Home visitation Hospitals Hypertension Incidence Inequity Intervention Knowledge Life Style Maternal Mortality Maternal and Child Health Measurement Mission Monitor Mothers National Institute on Minority Health and Health Disparities Outcome Patients Population Postpartum Period Pre-Eclampsia Pregnancy Psychiatry Race Recovery Research Risk Services Single-Blind Study Site Stroke System Testing Time Weight Woman Women&apos s Health black women blood pressure control clinical application clinical care community engagement community partnership community-level factor enhanced care evidence base experience feasibility trial health care disparity health care service health difference health equity health inequalities high risk improved innovation maternal morbidity mortality multidisciplinary novel post pregnancy postpartum complications pregnancy disorder pregnancy hypertension pressure prevent programs racial difference racial disparity racial minority population randomized trial recruit service delivery severe maternal morbidity social media socioeconomics treatment as usual trend trial comparing two-arm trial virtual intervention wireless

项目摘要

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.

抽象的美国严重的孕产妇发病率和死亡率事件的增加率不断提高伯恩斯黑人妇女不成比例。黑人妇女的可能性是白色的3至4倍妇女在怀孕期间或怀孕后因并发症而死亡。高血压疾病妊娠（HDP）（例如，先兆子痫，妊娠高血压）是严重的主要因素孕产妇的发病率和死亡率以及长期心血管疾病（CVD）。黑色的妇女比白人女性更有可能患有严重的HDP和严重的产后诸如慢性高血压，中风和CVD等并发症。我们有令人信服的初步记录了后产后血压恢复中种族分布的数据分娩后6周零12个月患有HDP的妇女。尽管总体下降趋势 HDP女性，黑人妇女的血压较高压力，更有可能在6周时具有2期高压（≥140/90 mmHg）产后与白人妇女（32.4％对18.2％，p <0.001）；持续存在的趋势交货后一年。我们建议在一个人的血压控制中降低血压控制中的种族差异通过利用我们的医院炎的6周家庭血液，在HDP女性的产后年度产后 HDP女性和我们新颖的社区合作者的压力监测计划（HBPM）使用Healthy Start Inc.多层次干预。我们的目标是：1）测试增强的护理干预措施策略（HBPM 6周，产后Doula教育和支持，12个月无线与通常的护理控制（HBPM 6周）相比，HBPM和体重监测）以改善 HDP女性的血压表现； 2）确定增强的护理策略是否会消除BP配置文件中的Rata差异，3）确定访问和交付对于所有妇女在一年内成功恢复的临床护理都是至关重要的产后。我们假设植根于健康公平的增强护理干预措施框架将改善HDP女性的产后血压回收率并将在一年之后的黑人和白人妇女之间弥补血压差异送货。我们的方法是进行一项平行的两臂试验，将454名妇女随机进行使用HDP（黑色75％，白色25％）进入通常的护理或增强的护理干预措施以改进分娩后一年的血压控制。改善血压控制对于预防慢性高血压的进展，减少高血压的种族差异，并改善妇女的整体健康状况。