What is this research about? Heart disease (e.g., heart attack, stroke) is a major threat
to safe motherhood and is the leading cause of maternal death in the United States,
responsible for nearly 50 percent of pregnancy-related deaths among Black women, three
times the rate of white women, and is largely preventable. It is well established that
eating healthy foods and monitoring blood pressure can help prevent heart disease. While
prior studies addressing these individual behaviors have led to some success, a single
individual-level approach has not been enough to stop the rising rate of Black maternal
mortality. Researchers have also established that depression, social isolation, and
stress from racism lead to poor heart outcomes. But few studies have treated these
psychosocial and structural factors in addition to individual behaviors to ensure optimal
Black maternal heart health, particularly for mothers at higher risk (e.g., those with
high blood pressure and/or obesity). To meet this need, the research team plans to
compare two approaches that treat multiple factors leading to heart disease among 432
patients age 18 and older who self-identify as Black or African American, have either
obesity and/or high blood pressure, are less than 24 weeks pregnant, and have a smart
phone. Both approaches address individual behaviors through nutrition and physical
activity text messages and home blood pressure self-monitoring as well as provide
training to medical care providers in order to reduce patients' experiences of racism or
mistreatment. But only one of the approaches being studied also adds supports for Black
women by Black women (community doula care, mental health services, and lactation
consultation) during their pregnancy, birth, and postpartum in order to learn if these
supports lead to lower blood pressure and also treat social isolation, depression, and
increase experiences of respectful maternity care.
Who can this research help? This study will increase Black mothers' understanding of the
many influences on their heart health. Findings from this study will help Black women
with obesity and/or high blood pressure make informed decisions about the use of
community doulas, lactation professionals, and psychotherapists as part of their care to
reduce risks for heart disease during pregnancy or in the first year after their baby is
born. Results may also strengthen health systems' commitment to anti-racism training as
part of their efforts to provide quality health care for Black pregnant and postpartum
people. And further, this research may provide evidence to insurance companies that
coverage of this study's package of supports is needed.
What outcomes are being studied? The primary outcomes are changes in maternal blood
pressure and body weight at six weeks and one year after giving birth. The team will also
evaluate how well the treatments are implemented and able to reach patients, be adopted
into practice consistently, and lead to healthcare provider and patient satisfaction. The
team will analyze outcomes that patient partners have identified as important. These
include perinatal mood and anxiety disorders (e.g., postpartum depression), emotional and
informational support, stress, and experiences of respectful maternity care. In addition,
the study team will look at clinical outcomes including if and for how long patients
breastfeed, blood pressure disorders of pregnancy, how the patient gave birth (e.g.,
vaginal or cesarean), baby's birth weight, and how many weeks pregnant mothers were at
the time of birth.
How long does this study last? Final follow-up of primary outcomes is at one year
postpartum (i.e., approximately 18 months from enrollment).
How are stakeholders involved? The research team believes that efforts to improve Black
maternal heart health will be most effective when partnered with patients and community
leaders that have shared lived experience. Study leadership is an equitable partnership
by an academic physician-researcher and community-based Black provider who herself
experienced heart health complications in her pregnancy. There are three other patient
investigators who will also be involved in all aspects of the planning, delivery, and
evaluation of the treatments, including serving as lead doulas, therapists, and lactation
professionals. Patient representatives will make up the majority of the study's advisory
board to give feedback and further guide the team's efforts throughout the five years of
the project. Finally, patient, health system, and community provider stakeholders will
provide feedback and guidance through focus groups over the entire study duration to
ensure adoption of treatments.