Study recruitment
Between June 2019 and May 2021, we recruited adult postpartum
individuals who had delivered within the past six months at one of two
tertiary care hospitals within a single hospital system (Magee-Womens
Hospital in Pittsburgh or Magee-Womens Hospital in Erie) or through our
partner community organization, Healthy Start, Inc. Healthy Start, Inc.
is a community-based organization that seeks to improve maternal and
child health, reduce poor birth outcomes and infant mortality as well as
eliminate perinatal health disparities in the Pittsburgh community.
Individuals were eligible if they had a pre-pregnancy body mass index
(BMI) in the overweight or obese range (≥25 kg/m2). If
pre-pregnancy weight was unknown, we used a weight measured clinically
in the first trimester of pregnancy. We enrolled participants between 6
weeks and 6 months postpartum if they had a pregnancy complicated by
gestational hypertension or preeclampsia according to American College
of Obstetricians and Gynecologists’ (ACOG) criteria (19), were ≥18 years
of age, English-speaking and had access to a device with internet
connectivity. Individuals were excluded if they had a pre-pregnancy
history of diabetes, chronic hypertension or were noted to have elevated
blood pressure (≥140 / 90 mmHg) before 20 weeks gestation, known
coronary artery disease, underlying chronic kidney disease
pre-pregnancy, autoimmune disease requiring medications, multifetal
gestation, stillbirth or neonatal death or were pregnant at the time of
enrollment. Inclusion criteria were evaluated through a phone or
in-person screen and medical record review by research staff.
Participants who became pregnant during the intervention were asked to
discontinue the intervention and were withdrawn from the study.
Participants who met inclusion criteria were either identified at the
time of delivery by the research study staff or in the postpartum period
during home visits by Community Health Workers at Health Start, Inc.
Eligible participants were identified by medical record review by the
study physician (AH) and pregnancy outcomes were adjudicated by two
independent physicians (AH& AJ) using ACOG criteria for diagnosis of
gestational hypertension and preeclampsia.(19) Before March 2020,
eligible participants were recruited during their postpartum
hospitalization. After March 2020, due to the Covid-19 pandemic and
restrictions on in-person research activities at our institution, all
recruitment and study procedures were conducted remotely via phone and
video visits. Individuals who were eligible following medical record
review were contacted either in person or via a recruitment letter
(after March 2020). All participants provided written informed consent.