PHILADELPHIA – New mothers with high blood pressure who participated in a post-partum remote blood pressure monitoring program were less likely to have post-partum complications, hospitalizations, and incurred less health care costs in the six months after delivery compared to mothers with high blood pressure who did not participate, according to a multi-year study from the Perelman School of Medicine at the University of Pennsylvania. The results, which spanned four years of data, were published last week in the journal Obstetrics and Gynecology.
Heart Safe Motherhood is a two-way text message-based program created and studied at Penn Medicine, which makes blood pressure monitoring after giving birth more convenient and links patients directly with their care teams from home. In the United States, preeclampsia, a high blood pressure condition, occurs during 1 in 25 pregnancies, and high blood pressure can continue or develop after delivery. While patients with preeclampsia, should have close blood pressure follow-up appointments after birth, many patients are unable to attend their recommended appointments due to schedule conflicts, childcare issues, or their babies’ appointments.
Patients who participate in the program receive twice-daily reminders to check their blood pressure and then send the results directly to their care team via text message through this program. If clinicians note any issues, they can quickly take action to provide care, including making changes to their medication or coming into the office for a visit, or, in more serious situations, going to the emergency department.
“Our previous work showed that Heart Safe Motherhood made important blood pressure monitoring easier and eliminated racial disparities in obtaining blood pressures in the two weeks after giving birth,” said study author Adi Hirshberg, MD, director of Obstetrical Services at the Hospital of the University of Pennsylvania, who along with, senior author of this study, Sindhu Srinivas, MD, a professor of Obstetrics and Gynecology at Penn, developed Heart Safe Motherhood. “What this study really solidified is that the benefits continue long-term. Close but remote tracking of blood pressure during this short yet pivotal time led to healthier moms months later.”
In this study, the researchers tracked multiple aspects of participants’ health over one year following childbirth. They analyzed patients who did and did not participate in the program, tracking any instances of conditions or events tied to high blood pressure. Those include heart attack, stroke, a blood clotting condition called disseminated intravascular coagulation (DIC), eclampsia, pulmonary edema, Hemolysis Elevated Liver Enzymes Low Platelets (HELLP) syndrome, and cardiomyopathy.
Every condition occurred less frequently in the group that participated in Heart Safe Motherhood. Additionally, while the Heart Safe Motherhood group had more cardiology visits, they had fewer emergency room visits, hospitalizations, and total health care costs during the six-month period, averaging a savings of about $100 per patient.
“Since the program allows for more frequent and purposeful blood pressure follow up in the 10 days immediately following discharge after birth, my colleagues and I believe that participants in the Heart Safe Motherhood group received timely treatment for their high blood pressures and any other necessary care,” said Srinivas. “Timely intervention, especially in those early postpartum days with this high-risk population, is key to reducing adverse outcomes.”
Srinivas and her Penn team believe that Heart Safe Motherhood can play a role in eliminating the inequities in maternal outcomes of non-white and white patients. Non-white patients are more likely to suffer adverse health events and more likely to have to miss medical appointments directly following delivery.
“While a program like Heart Safe Motherhood is good for everyone, we know that non-white, and especially Black patients, are more likely to have serious complications and even die after giving birth compared to their white peers,” said Srinivas. “Programs like this can help cut through any structural racism and socio-economic factors to improve health care access for all patients.”
Penn Medicine has been using Heart Safe Motherhood in its hospitals since 2019, and other health systems in the Philadelphia area and across the country have adopted the Penn program, too.
Contributing authors from Independence Blue Cross include Yifan Zhu and Aaron Smith-McLallen.
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $9.9 billion enterprise.
The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $546 million awarded in the 2021 fiscal year.
The University of Pennsylvania Health System’s patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center—which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report—Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is powered by a talented and dedicated workforce of more than 47,000 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2021, Penn Medicine provided more than $619 million to benefit our community.