Thursday, April 3, 2025
4/3/2025
Improving Maternal Cardiovascular Outcomes through the Implementation of a Hypertensive Disorders of Pregnancy Bundle in Nigeria - PROJECT SUMMARY Nigeria has the highest burden of maternal mortality globally with hypertensive disorders of pregnancy (HDP) contributing significantly to these deaths and posing long-term risks for adverse cardiovascular health. A large proportion of maternal deaths occur during the postpartum phase when care transitions between obstetricians and other providers. This phase has become crucial for monitoring and treating women, emphasizing the urgent need to address the knowledge-to-action gap in implementing evidence-based postpartum care practices. Dr. Mahmoud led the design and conduct of a feasibility study to contextualize and evaluate implementation of a postpartum blood pressure (BP) monitoring program in women with HDP in Abuja, Nigeria. The study achieved high adoption (100%) and 6-week retention rates (97%), demonstrating the feasibility of implementing a postpartum home BP monitoring program. Based on these findings, the program was adapted to address key barriers identified during the formative study resulting in the creation of the HDP Implementation Bundle. This career development award proposal includes a type 1 hybrid, stepped-wedge cluster randomized trial among 4 sites and 900 women with HDP in Nigeria, to evaluate the preliminary effectiveness and implementation of the HDP Implementation Bundle in improving postpartum BP control compared with usual care. The study will include a formative qualitative study to guide further adaptation of strategies included in the HDP Implementation Bundle using FRAME-IS, an evaluation of preliminary effectiveness that will be assessed by between-group difference in change in systolic BP from baseline to 6 weeks (primary outcome), and an assessment of implementation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. This proposal aligns with research priorities identified by NHLBI and will leverage implementation science frameworks to guide local adaptation and enhance success. Dr. Mahmoud proposes training in qualitative research methods, proficiency in implementation, translation and dissemination science to build on her background in cardio-obstetrics and health policy. This career development plan will offer pragmatic training in a highly supportive environment with experienced mentors led by Dr. Mark Huffman at Washington University in St. Louis alongside Drs. Ojji (Abuja), Dávila- Román (WashU) and Lindley (Vanderbilt). This career development award will provide the necessary training and support for Dr. Mahmoud to achieve her overarching goal of becoming an independent physician-scientist in global cardio-obstetrics. Insights gained from this study will pave way for a larger trial to assess the implementation and effects of the HDP Implementation Bundle on cardiovascular outcomes in a wider population through an R01 or similar-level grant to support the candidate’s development as an independent physician-scientist with expertise in global cardio-obstetrics.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).