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Patient Perspectives on Postpartum Interventions to Improve Future Maternal Cardiovascular Health After Gestational Diabetes

Dr. Christine Field, College of Medicine, Obstetrics and Gynecology (former fellow)
 

SUMMARY

Postpartum adverse cardiovascular health (CVH) is a critical public health problem and contributes to persistent and inequitable maternal health. Gestational diabetes (GDM) is the number one adverse pregnancy outcome associated with an increased risk of adverse postpartum CVH. Persistent and significant disparities exist both in the risk of GDM and suboptimal postpartum CVH due to adverse social determinants of health (SDOH). The association between GDM and adverse CVH after pregnancy is mediated by modifiable cardiometabolic risk factors, including prediabetes and type 2 diabetes, hypertension, obesity, and dyslipidemia. Evidence-proven interventions exist, but have failed to adequately address SDOH, structural, and patient-centered factors that limit patient uptake, adherence, and potential efficacy of effective interventions to improve maternal CVH. Additionally, preferences, desires and factors that influence engagement in postpartum interventions for individuals and their families are not well-characterized. The proposed study will evaluate the barriers to and facilitators of CVH counseling and risk-reduction postpartum at the patient and healthcare system levels inclusive of SDOH and structural factors, as well as patient preferences and perspectives on CVH and wellness interventions.

With an interdisciplinary team with expertise in high-risk obstetrics, epidemiology, qualitative methods, implementation science and patient engagement, we will engage individuals with a history of GDM through a patient-centered mixed-methods survey and qualitative assessment. For Aim 1, postpartum individuals with GDM already enrolled in a recently competed RCT will complete quantitative surveys at 12-24 months postpartum to examine the association between adverse SDOH and CVH prevention counseling and postpartum dysglyceria after a pregnancy complicated by GDM. For Aims 2 and 3, we will employ a convergent mixed-methods study design via semi-structured interviews among a subset of these participants to evaluate patient knowledge about adverse CVH, experiences of CVH counseling postpartum, perceptions and values surrounding wellness after a pregnancy with GDM, preferences relating to strategies to improve CVH, and barriers to and facilitators of engagement in risk-reduction strategies in the postpartum period. The long-term objective of this research is to provide foundational data to inform the development of a prospective study as a R01 clinical trial to NICHD or NHLBI on a multi-component postpartum intervention in the first year postpartum after a pregnancy complicated by GDM to improve and reduce disparities in CVH.

Project mentors (all from The Ohio State University): Dr. Kartik Venkatesh, College of Medicine, Obstetrics and Gynecology, Dr. Ann McAlearney, College of Medicine, Family and Community Medicine, Dr. Seuli Brill, College of Medicine, Internal Medicine, Dr. Sarah MacEwan, College of Medicine, Internal Medicine