High blood pressure during or after pregnancy (such as preeclampsia, gestational hypertension, eclampsia, or HELLP syndrome) raises a mother's risk of heart disease later in life. Many patients do not return for follow-up care after delivery, missing a key window to protect their heart health. The Alabama Womb to Heart Solution (AW2H) trial will test whether pairing postpartum patients with a trained community health worker (CHW) for 6 months lowers blood pressure compared with usual care.
A total of 174 postpartum patients who had pregnancy-associated hypertension or stage 2 high blood pressure will be randomly assigned (1:1) to usual care or usual care plus the AW2H CHW program. All participants receive education on measuring their own blood pressure and a pregnancy-validated home blood pressure monitor. Participants in the CHW group are also contacted regularly by a CHW for 6 months. CHWs coach home blood pressure monitoring, support taking blood pressure medications as prescribed, encourage heart-healthy habits based on the American Heart Association's Life's Essential 8, help schedule a primary care visit, provide mother-baby education (such as safe sleep and immunizations), and offer emotional support.
The main outcome is systolic blood pressure 6 months after enrollment, measured at home with the study-provided monitor while a research coordinator observes in person or by video/phone. The study will also look at diastolic blood pressure and whether participants scheduled a primary care visit. Interviews and focus groups will explore participant, CHW, and provider experiences with the program.
Postpartum patients with pregnancy-associated hypertension (gestational hypertension, preeclampsia, eclampsia, hypertension with superimposed preeclampsia, or HELLP syndrome) or stage 2 hypertension per ACC/AHA guidelines (SBP >=140 mmHg or DBP >=90 mmHg) on two separate occasions at delivery-related hospital discharge or during the postpartum period
Delivered in the last six weeks at >=14 weeks gestational age, including pregnancy loss
16-56 years old
Speaks and writes in English
Declines randomization
Does not speak English
Currently incarcerated
Currently enrolled in other community health worker studies or services
University of Alabama at Birmingham
Lead sponsor
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Collaborator
ConnectionHealth
Collaborator
Preeclampsia Foundation
Collaborator