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.

抽象的美国严重孕产妇发病率和死亡率不断上升黑人女性承受的负担比白人女性高出 3 到 4 倍。妇女在怀孕期间或怀孕后患有或死于高血压疾病。妊娠 (HDP)（例如先兆子痫、妊娠期高血压）是导致严重妊娠的主要原因孕产妇发病率和死亡率，以及长期心血管疾病 (CVD)。女性比白人女性更有可能患有严重的 HDP 和严重的产后疾病慢性高血压、中风和心血管疾病等并发症。记录产后血压恢复情况的种族差异的数据尽管总体呈下降趋势，但女性在产后 6 周和 12 个月时患有 HDP。患有 HDP 的女性产后血压，黑人女性血压更高压力，更有可能在 6 周时出现 2 期高血压 (≥140/90 mmHg) 产后与白人女性相比（32.4% vs.18.2%，p <0.001）；趋势持续至 1；我们建议将血压控制方面的种族差异缩小一倍。利用我们医院发起的为期 6 周的家庭血液治疗 HDP 女性产后一年针对 HDP 女性的压力监测计划 (HBPM) 和我们新颖的社区合作伙伴与 Healthy Start Inc. 进行多层次干预。我们的目标是：1) 测试强化护理干预策略（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，可改善 HDP 女性的血压状况；2) 确定强化护理策略是否有效消除 BP 资料中的种族差异，以及 3) 确定公平的获取和交付对于所有女性在一年内从 HDP 中成功康复至关重要的临床护理我们认为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情况并将在一年后缩小黑人和白人女性之间的血压差距我们的方法是进行一项平行的双臂试验，随机抽取 454 名女性。将 HDP（75% 黑人，25% 白人）纳入常规护理或强化护理干预以改善产后一年内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，以及全面改善女性健康。