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 Participants who became pregnant during the intervention were asked to discontinue the intervention and were withdrawn from the study.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.