Innovation in Postpartum Care for Women With Hypertensive Disorders of Pregnancy
Condition: Hypertension in Pregnancy; Hypertension, Pregnancy-Induced; Postpartum Preeclampsia; Blood Pressure Disorders
MeSH terms: Toxemia; Pre-Eclampsia; Hypertension, Pregnancy-Induced; Hypertension
Study type: Interventional

Summary: 
      Hypertensive disorders of pregnancy (HDP) affect up to 10% of mother-infant dyads and account
      for 7.4% of cases of maternal mortality in the United States. Prompt recognition and
      treatment of hypertension remain one of the key features of management of mothers affected by
      these conditions. Up to 41% of severe morbidity and mortality from HDP occurs after 48 hours
      postpartum, as postpartum blood pressures tend to peak 3-6 days after birth. For these
      reasons, early postpartum follow-up is recommended for women diagnosed with HDP, in the form
      of blood pressure (BP) evaluation by a health care provider at 7-10 days postpartum (2-5 days
      post-discharge from maternity care). However, barriers to follow-up limit mothers' ability to
      adhere to this recommendation. A potential alternative to in-office evaluation is at-home BP
      monitoring. At-home BP monitoring is a novel, affordable method to empower, educate, and
      engage postpartum women affected by HDP. Within the obstetric (OB) population, pilot studies
      have demonstrated the feasibility and acceptability of remote BP monitoring. Hence, the
      purpose of this randomized trial is to empower postpartum women affected by HDP and cared for
      at North Carolina Women's Hospital to perform at-home BP monitoring with the aid of digital
      technology.
    

Detailed description: 
      Hypertensive disorders of pregnancy (HDP) affect up to 10% of mother-infant dyads and account
      for 7.4% of cases of maternal mortality in the United States. Prompt recognition and
      treatment of hypertension remain one of the key features of management of mothers affected by
      these conditions. Improving recognition and treatment is of particular importance given that
      maternal mortality rates continue to rise in the United States. Moreover, mothers affected by
      HDP are at increased risk of long-term morbidity, such as cardiovascular disease,
      atherosclerosis, and persistent hypertension outside of pregnancy. Therefore, it is critical
      to recognize hypertension throughout maternity care, including in the postpartum period.

      The postpartum period is a time of major challenges for the new mother and considerable
      physiologic changes that place the new mother at increased risk of adverse events. For a
      postpartum woman with a diagnosis of a HDP, the risk of complications extends beyond
      discharge from maternity care: up to 41% of severe morbidity and mortality from HDP occurs
      after 48 hours postpartum, as postpartum blood pressures tend to peak 3-6 days after birth.
      For these reasons, the American College of Obstetricians and Gynecologists (ACOG) and the
      National Partnership for Maternal Safety recommend early postpartum follow-up for women
      diagnosed with HDP, in the form of blood pressure (BP) evaluation by a health care provider
      at 7-10 days postpartum. However, barriers to follow-up, including childcare arrangements,
      transportation access, and recovery from delivery, limit mothers' ability to adhere to this
      recommended in-office follow-up. Indeed, attendance at postpartum follow-up visits is poor
      and reflects significant disparities.

      A potential alternative to in-office evaluation is at-home blood pressure (BP) monitoring.
      At-home BP monitoring is a novel, affordable method to empower, educate, and engage
      postpartum women affected by HDP. This approach is not in widespread use in the US, despite
      the American Heart Association indicating that home BP monitoring is recommended for all
      people with high blood pressure. Within the obstetric population, pilot studies have
      demonstrated the feasibility and acceptability of remote BP monitoring. However, a randomized
      trial of postpartum at-home BP monitoring compared with office-based follow-up is lacking.
    

Intervention name(s): At-home Blood Pressure Monitoring
Intervention type(s): Other
Intervention description(s): Participants will use over-the-counter digital monitor to measure blood pressure and pulse rate at home. Automatically averages the last 3 readings taken over 10 minutes.
Other intervention name(s): Digital Blood Pressure monitoring cuff
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Supportive Care