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A team of Yale researchers, working collaboratively with Yale New Haven Hospital and community partners, is exploring ways to improve health outcomes for at-risk postpartum women with the support of a $ million funding award from the Patient-Centered Outcomes Research Institute (PCORI).
The award, announced March 8, will allow researchers at the Yale School of Public Health and Yale School of Medicine to compare the effectiveness of two community-based interventions designed to improve clinical outcomes among women in priority populations that have been historically underserved and experience systemic racism.
The two health care delivery models at the center of the study focus on the awareness, early detection, and control of postpartum hypertension as well as social and mental health factors known to affect maternal health.
“This study has the potential to transform the quality of care received by women of color and their babies in the period surrounding birth and beyond,” said Yale Professor of Public Health Rafael Pérez-Escamilla, Ph.D., co-leader of the study with Heather S. Lipkind, M.D., associate professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine. “These kinds of interventions are urgently needed. Poor blood pressure control, due to a lack of follow-up and identification during the postpartum period, is one of the drivers of racial inequities in maternal morbidity and mortality. These inequities are beyond the pale in the U.S. and totally unacceptable from both a public health and human rights perspective.”
More than 700 women die each year from pregnancy-related complications in the United States, even though the U.S. Centers for Disease Control and Prevention says two out of three of those deaths are preventable. Pregnancy risks are especially high among women in priority populations that have been historically underserved and that experience systemic racism. Black women in the U.S., according to the CDC, are more likely to die during pregnancy or childbirth than any other demographic.
Hypertensive disorders during and after pregnancy, including preeclampsia, gestational hypertension, and postpartum hypertension, have been identified as a major cause of maternal mortality and morbidity. Social determinants of health such as poverty, lower education, racism, and lack of access to health care (including mental health care) also contribute to maternal mortality and morbidity rates and health inequities.
In the PCORI-funded study, clinical outcomes for each intervention will be compared with the current standard of care for postpartum mothers. The effectiveness of each intervention will also be compared with the effectiveness of the alternate intervention. The project’s overall goal is to improve mean postpartum systolic blood pressure at six weeks and reduce depression severity at three months postpartum.
“Growing attention has focused on the postpartum period as an important window to address maternal mortality disparities, as half of pregnancy-related deaths occur postpartum,” said Lipkind. “We are thrilled with the opportunity to partner with the community and medical centers to address this critical time period in women’s lives.”
One intervention will use a remote medical service model that includes home blood pressure monitoring, weekly virtual visits by a health care provider (such as a nurse practitioner or pharmacist) and screening for mental health concerns such as anxiety and depression with referral for services if necessary. The second intervention will be based on a community health model that utilizes community health workers trained in a strength-based trauma approach.
In designing the interventions, project leaders worked with mothers who have experienced hypertension and community doulas. Pérez-Escamilla said the project’s informed design is a “prime illustration of what happens when different units within and across academic institutions come together and work unselfishly side by side with community partners.”
New Haven Healthy Start Director and Senior Community Investigator and Advisor for the project Natasha Ray, M.S., worked closely with researchers in designing the interventions, ensuring that the community engagement aspect is “meaningful, equitable, culturally respectful, and valued.”
“Typically, guidelines and recommendations for management of hypertension in pregnancy are written for implementation in an ideal setting, and that is not always possible,” Ray said. “We aim to support timely recognition and response to maternal hypertension and preeclampsia utilizing a community-driven, family-centered, and trauma-informed approach. Partnering with the individuals most impacted by the issue will yield us our greatest results.”
The PCORI funding award was approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed health care decisions.