Women with recent pregnancy complications, such as gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy (HDP), have an increased risk of developing cardiovascular disease (CVD). Pregnancy provides a unique opportunity to identify women with these vascular risk factors earlier in life. Yet, we are missing this window of opportunity, as women are often lost to follow- up postpartum and do not received recommended care. There is a paucity of evidence on how to effectively promote and sustain CVD-preventive health behaviors in this high risk population. The overall objective of the proposed study is to identify barriers to and predictors of CVD-preventive health behaviors, including medical follow-up and healthy lifestyle behaviors, in the postpartum period in women with recent GDM and HDP. Using the PRECEDE-PROCEED model, we will use these findings to develop an interventional study to address the predisposing, enabling and reinforcing factors that influence CVD-preventive health behaviors. Results from this proposal could have broad implications for the development of practical and sustainable strategies to decrease CVD morbidity and mortality in women.
The specific aims are to: 1) conduct a retrospective cohort study to describe healthcare utilization patterns and predictors of follow-up medical care in the first year postpartum in women with GDM and/or HDP;2) conduct a prospective cohort study to determine predictors CVD-preventive behaviors in the first year postpartum in women with GDM and/or HDP;3) design and carry-out a pilot multilevel educational-behavioral intervention to increase CVD-preventive health behaviors in women with GDM and/or HDP. The candidate is completing a clinical research fellowship in General Internal Medicine (GIM) at Johns Hopkins University School of Medicine and will take an Assistant Professor post at Johns Hopkins in July, 2009. Her primary mentor is Dr. Jeanne Clark, Associate Professor of Medicine and Epidemiology, with extensive experience in mentoring, epidemiology, and the design of clinical trials. Her co-mentor is Dr. David Levine, Professor of Medicine, principal investigator of the NHLBI training grant on behavioral aspects of CVD and an established investigator and mentor. The candidate's long term career goal is to establish an independent research program in the primary prevention of CVD in women. To accomplish this goal, her short term goals involve a career development plan to enhance her skills in longitudinal data analysis, health survey research, health behavior science, and the design and conduct of clinical trials. Results of this proposal will lead to the development of a pilot intervention in years 4 and 5 and an R01 proposal early in year 5 to investigate the effectiveness of an intervention to improve CVD-preventive health behaviors in the postpartum period in women with recent GDM and/or HDP.

Public Health Relevance

Women with recent high blood pressure or diabetes in pregnancy have an increased risk of developing heart disease later in life. However, many women are lost to follow-up after delivery and do not receive recommendations promoting continued medical surveillance and healthy lifestyle changes to reduce their heart disease risk. The purpose of this study is to identify barriers for women to receive medical follow-up care and engage in healthy lifestyle behaviors in the postpartum period, in order to design effective strategies to decrease their risk of heart disease. (End of Abstract)

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL098476-04
Application #
8502542
Study Section
Special Emphasis Panel (ZHL1-CSR-R (O1))
Program Officer
Einhorn, Paula
Project Start
2010-08-20
Project End
2015-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
4
Fiscal Year
2013
Total Cost
$139,695
Indirect Cost
$10,348
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Harris, Ashley; Chilukuri, Nymisha; West, Meredith et al. (2016) Obesity-Related Dietary Behaviors among Racially and Ethnically Diverse Pregnant and Postpartum Women. J Pregnancy 2016:9832167
Bleich, Sara N; Bandara, Sachini; Bennett, Wendy L et al. (2015) U.S. health professionals' views on obesity care, training, and self-efficacy. Am J Prev Med 48:411-8
Harris, Ashley; Chang, Hsien-Yen; Wang, Lin et al. (2015) Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis. J Womens Health (Larchmt) 24:745-54
Jarlenski, Marian P; Chisolm, Margaret S; Kachur, Sarah et al. (2015) Use of pharmacotherapies for smoking cessation: analysis of pregnant and postpartum Medicaid enrollees. Am J Prev Med 48:528-34
Bennett, Wendy L; Wang, Nae-Yuh; Gudzune, Kimberly A et al. (2015) Satisfaction with primary care provider involvement is associated with greater weight loss: Results from the practice-based POWER trial. Patient Educ Couns 98:1099-105
Chilukuri, Nymisha; West, Meredith; Henderson, Janice Lynn et al. (2015) Information and Communication Technology Use Among Low-Income Pregnant and Postpartum Women by Race and Ethnicity: A Cross-Sectional Study. J Med Internet Res 17:e163
Gudzune, Kimberly A; Bennett, Wendy L; Cooper, Lisa A et al. (2014) Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships. Obesity (Silver Spring) 22:1952-5
Mongraw-Chaffin, Morgana L; Anderson, Cheryl A M; Clark, Jeanne M et al. (2014) Prepregnancy body mass index and cardiovascular disease mortality: the Child Health and Development Studies. Obesity (Silver Spring) 22:1149-56
Jarlenski, Marian P; Bennett, Wendy L; Bleich, Sara N et al. (2014) Effects of breastfeeding on postpartum weight loss among U.S. women. Prev Med 69:146-50
Jarlenski, Marian; Bleich, Sara N; Bennett, Wendy L et al. (2014) Medicaid enrollment policy increased smoking cessation among pregnant women but had no impact on birth outcomes. Health Aff (Millwood) 33:997-1005

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