Collaboration Between Maternal and Child Health and Chronic Disease Epidemiologists to Identify Strategies to Reduce Hypertension-Related Severe Maternal Morbidity

Abstract

IntroductionMaternal and child health (MCH) and chronic disease programs at state health agencies may not routinely collaborate. The objective of this study was to describe a project that enhanced relationships between MCH and chronic disease epidemiologists at the Florida Department of Health, increased epidemiologic capacity, and informed both programs.MethodsWe collaborated to assess hypertension-related severe maternal morbidity (H-SMM) and hypertensive disorders (preexisting hypertension, gestational hypertension, and preeclampsia) among women at delivery of their live birth to help determine the burden on health care systems in Florida. We identified ways to improve the health of women before they conceive and to help them manage any chronic diseases during the perinatal period.ResultsWe found differences by maternal characteristics in H-SMM rates among 979,660 women who delivered live births. We proposed strategies to support collaboration between state MCH and chronic disease staff. First, increase the screening, monitoring, and management of hypertension before, during, and after pregnancy. Second, examine H-SMM concurrently with maternal mortality to help find prevention strategies. Third, include reproductive-aged women in ongoing hypertension prevention and intervention efforts. Fourth, expand team-based care to include obstetricians, midwives, and doulas who can work together with primary care providers for hypertension management. And fifth, create and share data products that guide various groups about hypertension and related risk factors among reproductive-aged women.ConclusionThe collaboration between the Florida Department of Health MCH and chronic disease epidemiologists produced 1) a program-relevant indicator, H-SMM and 2) strategies for enhancing program and clinical activities, communication, and surveillance to reduce H-SMM rates.

Postpartum health risks among women with hypertensive disorders of pregnancy, California 2008–2012

“…We focused on women with HDP, who are known to be at an increased risk of cardiovascular disease [4,5,7], hypertension-related severe maternal morbidity [16] and mood 1 for the condition-specific diagnostic categories included in each major category. The most common conditions in each major category were hypertensive disorders and acute cardiovascular disease (hypertension-related); urinary tract infection and uncontrolled pain (childbirth-related); and nonspecific postpartum diagnosis and gallbladder disease/ pancreatitis (other).…”

“…We focused on women with HDP, who are known to be at an increased risk of cardiovascular disease [4,5,7], hypertension-related severe maternal morbidity [16] and mood disorders [8] after delivery. In this study, HDP was associated with virtually all postpartum complications: the three major categories (hypertensive, childbirth-related and other) and most condition-specific diagnostic categories.…”

“…However, little is known about the type and timing of postpartum complications beyond the traditional 6-week postpartum period. Furthermore, studies vary in their definitions of postpartum complications and have often restricted their analyses to a subset of diagnoses [3,10,[14][15][16][17]. A broader understanding of postpartum risk throughout the 12-week transition is needed to optimize the care of women after giving birth.…”

State and Local Health Departments: Research, Surveillance, and Evidence-Based Public Health Practices

“…The Arkansas Department of Health partnered with local barber and beauty shops to conduct screening programs for chronic conditions ( 13 ). Practitioners from the Florida Department of Health collaborated with CDC and the Council of State and Territorial Epidemiologists (CSTE) to examine severe maternal outcomes related to hypertension ( 24 ). Partnerships with organizations help strengthen the public health infrastructure that will ultimately improve the health and well-being of our communities.…”

Using a Patient Work System Model to Systematically Assess the Social Determinants of Health

“…The demand for patient work activities that require accessing transportation is notably complex and dynamic across the maternal care continuum. Prenatal and postpartum care and chronic disease management are critical to preventing adverse outcomes (Gadson et al, 2017;Phillips-Bell, 2019;Wang et al, 2020). Especially among low-income individuals who are eligible for assistance from the Women, Infants, and Children (WIC) program, frequent travel to a clinic site is necessary to receive benefits.…”