UMass Chan School of Medicine researchers are collaborating with researchers from Yale University and the University at Buffalo to examine increasing levels of outreach and home support to improve postpartum maternal health among historically underserved and at-risk populations.
A five-year period of nearly $20 million in funding, supported by the Institute for Patient-Centered Outcomes Research, begins in early November at UMass Chan.
“The study aims to address the public health crisis of rising maternal mortality in the US, particularly given that it disproportionately affects populations marginalized by racism and socioeconomic disadvantage,” said the site’s principal investigator Tiffany Moore Simas, MD, MPH, MEd, Donna M. and Robert J. Manning Department of Obstetrics and Gynecology and Chair and Professor of Obstetrics and Gynecology. “It does this by targeting the most common causes of preventable maternal mortality and morbidity – cardiovascular conditions, including hypertension and mental illness – and we’re trying to do it in a way that will be sustainable and can continue beyond the survey.’
The study included a “stepped-wedge design” in which each of the three sites would sequentially layer two interventions outside of the routine standard of care, Dr. Moore Simas explained. Sites will add these interventions in a staggered manner.
Beginning around May 2024, eligible postpartum patients seen by UMass Memorial Health physicians will be connected to obstetrician (OB) extenders, who at UMass Chan will be nurse practitioners who make phone calls to patients at home. Patients will monitor their blood pressure remotely, which is monitored by the nurse. Obstetricians will also screen for and address depression and anxiety.
A second scaled-up intervention, called the community health model, will begin locally around February 2026. In addition to telehealth from midwifery extenders, patients will be matched with community health workers, such as postpartum doulas, who will visit patients; to screen them for social determinants of health such as housing, employment and food security; and connect them to resources.
“Throughout the study, all caregivers interacting with perinatal individuals will receive anti-racism and trauma-informed care training. Some caregivers will receive additional training on how to deal with mental health issues and blood pressure control, along with a parenting intervention to support parent-child attachment and how to assess the social determinants of health and the connection to the necessary resources. Moore Simas said.
The project primarily aims to improve mean systolic blood pressure at six weeks postpartum and reduce the severity of depression at three months postpartum.
“About 10% to 15% of all pregnancies are affected by hypertensive disorders, which includes gestational hypertension, chronic hypertension, or preeclampsia,” said Lara Kovel, MD, assistant professor of medicine and co-investigator. “A large proportion, about 50 percent, remain hypertensive after delivery, and another 10 percent of those with normal blood pressure during pregnancy develop hypertension in the postpartum period. Hypertension is one of the main reasons our patients are admitted to hospital in the postpartum period.”
Nancy Bayat, DO, professor of psychiatry, obstetrics and gynecology, population and quantitative health sciences, who is the site manager for the mental health aspects of the study, said this research builds on what UMass Chan developed in partnership with professional organizations to integrate screening, assessment and treatment of anxiety and depression into the midwifery workflow.
“We focus on mental health in addition to hypertension because medical conditions don’t fit in a box. They arise in the context of mental health and overall family health, both of which are often affected by trauma or adverse experiences,” said Dr. Bayat. “We will train caregivers to provide mental health care using a trauma-informed and relational health approach. We are also adding testing approaches that take place near the medical facility, rather than in the medical facility.”
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