Adverse pregnancy outcomes (APO), including hypertensive disorders of pregnancy, preterm
birth, small for gestational age birth, and gestational diabetes, are associated with
cardiovascular disease (CVD) risk in mothers. The Nulliparous Pregnancy Outcomes Study:
Monitoring Mothers-To-Be (nuMoM2b) collected biospecimens during pregnancy and extensive
phenotyping data for 10,038 nulliparous women from 2010-13. The nuMoM2b Heart Health
Study is comprised of 7,003 nuMoM2b participants who were recontacted at least once after
their nuMoM2b birth, 4,508 of whom returned for an in-person CVD risk factor assessment 2-7
years later. This cohort is currently in a second phase of followup, with multiple ancillary studies
running in parallel, and is uniquely positioned to address questions about the complex interplay
of APOs and maternal CVD. Unfortunately, the network is facing several challenges related to
the downstream effects of the COVID-19 pandemic. We propose four activities to address these
challenges, improve participant engagement, and expand the network infrastructure:
• Increasing participant incentives. Prior increases in incentives have resulted in improved
rates of survey completion. We plan an additional increase, reflecting the significant time
investment and commitment of our study participants.
• Increasing study network support. Downstream effects of the COVID-19 pandemic
include reduced participant engagement with research studies and increased rates of
missed study visits, which increase the time required to complete planned activities.
Increasing the level of support to network sites will improve their ability to respond to
these challenges and build network resilience.
• Implementing a pilot study of remote visits. Since the original time of enrollment in
nuMoM2b, about 30% of study participants have moved away from their network sites
and are no longer located within a travel distance that allows them to attend in-person
study visits. We propose to complete a pilot study of remote visits using a national
network of mobile phlebotomists to evaluate remote visits as a strategic approach to
maintaining engagement of these participants.
• Sustaining infrastructure. To further improve participant engagement, the network will
convene a Participant Engagement Committee and expand its online informational
content. In addition, analytic support to network investigators will be expanded and
recently collected data will be prepared for release to support timely reporting of results.