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.