INTRODUCTION
Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia complicate 8-10% of pregnancies in the United States. The association of HDP with later-life cardiovascular disease (CVD) is well-established and has been replicated in diverse populations across multiple studies.(1–4) Recent data suggest 30-40% of previously normotensive individuals progress to chronic hypertension in the first year following HDP, which is likely a key contributor to CVD risk.(5,6) In overweight and obese individuals, that risk is further amplified, with prior studies demonstrating that over 50% have sustained hypertension at one-year postpartum.(7) Despite this, few interventions have been studied to mitigate risk in this population.(8)
Traditional in-person interventions, such as regular appointments and counseling from a primary care doctor or nutritionist may promote lifestyle changes in the general adult population, but this has not been as successful for primary prevention in a postpartum population, likely due to competing demands and time constraints.(9–11) However, following a pregnancy complication, the immediate postpartum period is a time when individuals may be particularly motivated to improve their health, both before the next pregnancy and long-term.(12,13) Self-monitoring via home blood pressure monitoring as a tool to lower blood pressure is supported by robust evidence in the general adult population. When self-monitoring of home blood pressure is combined with additional support (education, counseling, individualized feedback, patient navigator), further lowering of blood pressure is achieved in a general hypertensive population.(14) Internet-based lifestyle interventions implemented in the immediate postpartum period promote weight loss in individuals with a history of gestational diabetes and show high engagement and retention postpartum (15,16) but these are not well-studied in individuals after HDP. Prior postpartum intervention studies have had high attrition rates, which suggested that postpartum individuals may not be willing to participate in intervention studies due to the competing demands of the immediate postpartum period, highlighting the need for a feasibility study prior to proceeding with a large-scale randomized trial.(17,18)
The initial Heart Health 4 Moms study developed a remote lifestyle intervention that was internet-based and mobile-device compatible which demonstrated improvement in knowledge of CVD risk and self-efficacy to achieve a healthy diet and decreased physical inactivity among predominantly white and highly educated postpartum individuals within the first five years following a pregnancy complicated by preeclampsia.(8) Our primary aim in this three-arm trial was to examine the feasibility of conducting a randomized controlled trial comparing home blood pressure monitoring plus the internet-based lifestyle intervention, Heart Health 4 New Moms (HH4NM) compared to home blood pressure monitoring alone compared to a control arm, in a racially and socioeconomically diverse sample of overweight and obese individuals with a hypertensive disorder of pregnancy in the first year postpartum. Our secondary aims were to test whether the interventions (HH4NM +HBPM or HPBM alone) would lower weight and blood pressure compared to controls.