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.
