Postpartum Support Boosts Follow-Up and BP Control After HDP
Key Takeaways
- In a Midwestern US community-hospital trial, postpartum women with hypertensive disorders of pregnancy and ongoing hypertension risk received either a multicomponent first-year support program or usual care.
- Participants assigned to the support program were more likely to attend primary care follow-up within the first postpartum year.
- In exploratory secondary analyses, blood pressure control below 130/80 mm Hg was more common with the intervention, and self-measured systolic and diastolic blood pressure declined more over follow-up.
- Self-reported physical activity and most dietary measures were similar between groups, and adverse events were uncommon and unrelated to the trial.
In a JAMA Network Open trial of postpartum coaching and self-measured blood pressure after hypertensive pregnancy, investigators randomized 140 postpartum women aged 18 years or older at a single Midwestern US community hospital. Enrollment occurred at about 6 weeks post partum after completion of a hospital-based remote blood pressure program. Eligibility required hypertensive disorders of pregnancy (HDP) plus chronic hypertension, continued antihypertensive use, or persistent uncontrolled blood pressure (BP) at that time point. Staying Healthy After Childbirth–My Hypertension Education And Reaching Target Post Partum (STAC-MyHEARTp) paired self-measured blood pressure (SMBP) review with telephone health coaching, home weight checks, personalized SMART goals, barrier review, and coordination with a primary care physician (PCP) or help identifying one when needed, versus usual care. The primary outcome was PCP visit attendance by 12 months post partum; secondary outcomes were BP control, mean systolic and diastolic BP, and health behaviors. Investigators used block randomization, analyzed the primary outcome by intention to treat, and powered the trial for the primary end point only; the trial was registered as NCT05685251.
Primary outcome data were available for 69 of 70 participants in each group, and intervention exposure was substantial, with a median of 12 coaching calls. By 12 months post partum, 49 of 69 participants (71%) in the intervention group versus 27 of 69 (39.1%) in the control group attended a primary care visit; RR, 2.00 (95% CI, 1.34-2.97); P < .001. The intervention was associated with more successful reconnection to primary care during the first postpartum year.
Self-measured BP outcomes also favored the intervention, with a mean difference in systolic BP of −5.6 mm Hg (95% CI, −9.4 to −1.7; P = .005) and a mean difference in diastolic BP of −4.5 mm Hg (95% CI, −7.7 to −1.3; P = .006). Blood pressure below 130/80 mm Hg was achieved by 26 of 47 participants (55.3%) versus 19 of 61 (31.1%); RR, 1.73 (95% CI, 1.13-2.66); P = .02. Documented office BP did not differ significantly between groups, self-reported physical activity did not differ significantly, and most dietary measures were also similar, although fat intake shifted modestly in the intervention direction. Adverse events were uncommon in both groups and were judged unrelated to the trial.
This single-site Midwestern trial enrolled only patients who had completed a hospital-based 6-week remote BP monitoring program, so the findings apply most directly to postpartum populations already engaged in structured follow-up. Limited racial heterogeneity and higher attrition for secondary outcomes further narrowed certainty around those analyses, which the authors treated as exploratory because of missingness and lack of multiplicity adjustment. Follow-up ended at 12 months post partum, leaving longer-term BP control, sustained care engagement, and cardiovascular outcomes beyond the first postpartum year unresolved.
The authors concluded that this multicomponent postpartum support model increased health care engagement and improved BP outcomes through 12 months post partum, while self-reported activity and nutrition changes were less distinct between groups. In their interpretation, extending SMBP review, coaching, and navigation beyond the early postpartum period was associated with a stronger handoff into primary care after hypertensive pregnancy.
Clinician Questions
Which postpartum patients do the STAC-MyHEARTp findings apply to after hypertensive disorders of pregnancy?
The findings apply most directly to postpartum women aged 18 years or older who were identified at about 6 weeks post partum and had hypertensive disorders of pregnancy plus chronic hypertension, continued antihypertensive medication use, or persistent uncontrolled BP. Because all participants had already completed a hospital-based remote BP monitoring program, the results are most directly relevant to similarly monitored postpartum populations rather than to all patients after hypertensive pregnancy.
How intensive was coaching exposure in the STAC-MyHEARTp postpartum intervention?
Calls occurred every other week for 4 months and then monthly for 6 months, with review of SMBP readings, home weight, goals, barriers, and PCP coordination. Engagement was substantial, with a median of 12 coaching calls, 81.2% of participants completing all 8 high-dose calls, and 30.5% completing all 6 maintenance-phase calls.
Why were the blood pressure and health behavior secondary outcomes treated as exploratory in this postpartum trial?
The BP and health behavior outcomes were treated as exploratory because the trial was powered for primary care attendance only, and the secondary analyses had outcome-specific missingness after randomization without multiplicity adjustment. The authors also noted higher attrition in the intervention arm for trial-end follow-up, which further limited certainty around those secondary findings.
What remained unknown after 12 months post partum in this care-navigation and SMBP trial?
The trial did not assess whether the intervention changed BP control, care engagement, or cardiovascular outcomes beyond the first postpartum year. Its single-site setting and the participants' prior completion of a remote BP monitoring program also leave open questions about how the model would perform in broader postpartum populations.