UMass Chan study targets maternal health, hypertension, mental health risks with postpartum intervention

UMass Chan Medical School researchers are collaborating with researchers at Yale University and the University of Buffalo to study increasing levels of home care and support to improve maternal health in the postpartum period among historically disadvantaged and at-risk populations.

The five-year funding period of nearly $ 20 million backed by the Patient-Centered Outcomes Research Institute begins in early November at UMass Chan.

Tiffany Moore Simas, MD, MPH, MD

“The study aims to address the public health crisis of rising maternal mortality in the United States, especially as it disproportionately affects populations marginalized by racism and socioeconomic disadvantage,” said site principal investigator Tiffany Moore Simas , MD, MPH, MEd, the Donna M. and Robert J. Manning Chair in Obstetrics and Gynecology and chair and professor of obstetrics and gynecology. “It is doing this by targeting the most common causes of preventable maternal mortality and morbidity – cardiovascular conditions including hypertension and mental health conditions – and we are looking to do so in a way that is sustainable and can continue beyond the study.”

The study involves a “stepped wedge design,” in which each of the three sites will sequentially overlap two interventions beyond the standard of routine care, explained Dr. Moore Simas. The sites will add these interventions in staggered times.

Beginning in May 2024, eligible postpartum patients seen by UMass Memorial Health physicians will be contacted by obstetric extenders (OBs), who at UMass Chan will be nurses phoning patients at home. Patients will remotely monitor their blood pressure, which the professional nurse examines. OB extenders will also examine and address depression and anxiety.

The second intensified intervention, called the community health model, will begin locally around February 2026. In addition to remote medical care from the OB extenders, patients will be paired with community health workers such as postpartum doules who will visit patients; examine them for social determinants of health such as housing, employment and food security; and link them with resources.

Lara Kovell, MD

“Throughout the entire study, all caregivers interacting with perinatal individuals will receive training on informed trauma and anti-racism care. A subset of health professionals will receive additional training on how to address mental health and control issues. blood pressure, along with parental intervention to help with parent-child attachment and how to assess the social determinants of health and connect with the necessary resources. ” Moore Simas said.

The project mainly aims to improve mean systolic blood pressure after delivery at six weeks and to reduce the severity of depression at three months after delivery.

“About 10-15 percent of all pregnancies are affected by hypertensive disorders, which include gestational hypertension, chronic hypertension or preeclampsia,” said Lara Kovell, MD, assistant professor of medicine and co-researcher. “A good portion, about 50 percent, remain hypertensive after childbirth and another 10 percent of those with normal blood pressure in pregnancy develop hypertension in the postpartum period. Hypertension is one of the main reasons why our patients are hospitalized in the postpartum period. “

Nancy Byatt, DO

Nancy Byatt, DO, professor of psychiatry, obstetrics and gynecology and population and quantitative health sciences, who is the site manager on the mental health aspects of the study, said this research builds on what UMass Chan has developed in partnering with professional organizations to integrate anxiety and depression screening, assessment and treatment into obstetric workflow.

“We are focusing on mental health in addition to hypertension because medical conditions don’t happen in a box. They occur in the context of mental health and general family health, both of which are often affected by trauma or adverse experiences, “said Dr. Byatt.” We will train health care workers to provide mental health care using a trauma-informed, relational health approach. We are also adding testing approaches that take place in close proximity to the medical environment, rather than in the medical setting. “

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