PROJECT SUMMARY
Cardiovascular disease (CVD) is the leading cause of death in the United States, with disparately greater impact
on racial/ethnic minorities and lower-income individuals. Risk for CVD begins very early in life as adverse
exposures during critical periods (fetal development, infancy, and reproductive years) shift the health trajectory
toward overt disease. Thus, efforts to promote and maintain cardiovascular health (CVH) from pregnancy onward
are crucial to reducing the intergenerational burden of CVD. In response to the Early Intervention to Promote
Cardiovascular Health of Mothers and Children request for applications (ENRICH RFA), we propose to leverage
two widely-available interventions to promote CVH in diverse, under-resourced pregnant women and offspring:
Nurse Family Partnership (NFP) and the National Diabetes Prevention Program (NDPP). NFP is a home visiting
program in which nurses support first-time, under-resourced mothers from pregnancy to 24 months postpartum
to improve prenatal outcomes, child safety and developmental outcomes, and economic self-sufficiency. NFP is
available at >260 organizations nationwide, including our Denver Health partners who have delivered it to >2400
urban, under-resourced women since 2000. While NFP addresses some putative causes of compromised
maternal and child health, CVH has not been comprehensively addressed nor evaluated. Thus, we propose to
enhance NFP with CVH-focused programming adapted from the NDPP, a yearlong, evidence-based lifestyle
intervention that promotes healthy eating and activity to reduce weight, dysglycemia, and other CVD risks, which
we have delivered to >1600 diverse, under-resourced adults at Denver Health since 2013, including >340 young
women. By leveraging unique strengths of NFP (home delivery model, professional nursing support, impact on
social determinants of health [SDOH]) with those of NDPP (evidence-based content for CVH promotion), a
combined intervention (NFP-Heart) rigorously evaluated in the ENRICH program has great potential to improve
CVH outcomes in under-resourced populations. Our Colorado Nurse Family Heart Trial will evaluate NFP-Heart
versus usual care among 600 nulliparous women (and their offspring) recruited in early pregnancy from 10 clinics
in a safety-net, urban healthcare system. NFP-Heart will promote intergenerational CVH with programming
delivered from 20 weeks gestation to 24 months postpartum by home visiting nurses. Our specific aims are 1)
develop the local NFP-Heart and common ENRICH protocols, and conduct pilot studies to confirm feasibility and
acceptability; 2) evaluate the effect of NFP-Heart on maternal and offspring CVH metrics; 3) assess the degree
to which SDOH modify the effect of the NFP-Heart intervention on maternal and offspring CVH outcomes; and
4) examine the implementation of the NFP-Heart intervention and potential for sustainability using a mixed-
methods approach.