Researchers from UMass Chan Medical School are collaborating with researchers from Yale University and the University at Buffalo to study increasing levels of awareness and support at home to improve maternal health in the post-natal period. partum among historically underserved and at-risk populations.
The nearly $20 million, five-year funding period supported by the Patient-Centered Outcomes Research Institute begins in early November at UMass Chan.
“The study is intended to respond to the public health crisis of increasing maternal mortality in the United States, especially as it disproportionately affects populations marginalized by racism and socioeconomic disadvantage. “said the site’s lead researcher, Tiffany Moore Simas, MD, MPH, MEd, on Donna M. and Robert J. Manning Chair in Obstetrics and Gynecology and President 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 health issues – and we are trying to do this in a way that will be sustainable and that may continue beyond the study.
The study involves a “tiered design,” in which each of the three sites will sequentially apply two interventions beyond the routine standard of care, Dr. Moore Simas explained. Sites will add these interventions at staggered times.
Beginning approximately May 2024, eligible postpartum patients seen by physicians at UMass Memorial Health will be contacted by obstetrical extenders (OBs), who at UMass Chan will be nurse practitioners who will telephone patients in their homes. Patients will remotely monitor their blood pressure, which the nurse practitioner will review. OB extenders will also screen for and treat depression and anxiety.
The second scaled-up intervention, called the community health model, will begin locally around February 2026. In addition to remote medical care from OB extenders, patients will be matched with community health workers such as postpartum doulas who will visit patients ; screen them for social determinants of health such as housing, employment and food security; and connect them with resources.
“Across the entire study, all caregivers who interact with perinatal individuals will receive training in anti-racism and trauma-informed care. A subset of caregivers will receive additional training on how to deal with mental health and blood pressure control issues, as well as parental intervention to help with parent-child attachment, and how to assess social determinants health and connect with the necessary resources,” says Moore Simas.
The main goals of the project are to improve mean postpartum systolic blood pressure at six weeks and reduce the severity of depression at three months postpartum.
“About 10 to 15 percent of all pregnancies are affected by hypertensive disorders, including gestational hypertension, chronic hypertension, or preeclampsia,” said Lara Kovell, MD, assistant professor of medicine and co-investigator. “A good portion, about 50%, remain hypertensive after childbirth and 10% of those with normal blood pressure during pregnancy develop hypertension in the postpartum period. Hypertension is one of the main reasons for which our patients are admitted to hospital in the postpartum period.
Nancy Byatt, DO, professor of psychiatry, obstetrics and gynecology, and quantitative and population health sciences, who is the site manager for the mental health aspects of the study, said this research s builds on what UMass Chan has developed in partnership with professional organizations to integrate screening, assessment, and treatment for anxiety and depression into the obstetrical workflow.
“We focus on mental health in addition to hypertension because medical conditions don’t happen in a box. They arise in the context of mental health and overall family health, which are often affected by trauma or negative experiences,” Dr. Byatt said. “We will train caregivers to provide mental health care using a relational health and trauma-informed approach. We are also adding testing approaches that take place alongside the medical setting, rather than within a medical setting.
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