New Longitudinal Study Will Fill Gap in Data on Postpartum Health and Well-being.
New Longitudinal Study Will Fill Gap in Data on Postpartum Health and Well-being
The Postpartum, Lifestyle & Cardiovascular Evaluation Study, a survey-based, online study led by School of Public Health and Boston Medical Center researchers, will capture information about the health complications and social needs that patients experience after having a baby.
Breastfeeding difficulties, hypertension, depression, and sleep deprivation are just a handful of the health challenges that mothers may experience in the weeks and months following childbirth. Although millions of people struggle with these complications after having a baby, postpartum health remains a neglected aspect of maternal healthcare, with far less data on the postnatal period, compared to prenatal months.
Researchers at the School of Public Health and Boston Medical Center pledge to fill this dearth of knowledge with the launch of the Postpartum, Lifestyle & Cardiovascular Evaluation Study (PLACES). The online, survey-based longitudinal study will collect data from postpartum patients at BMC to better understand the key clinical and social drivers that impact a person’s health during postpartum, often called the “fourth trimester.”
“The postpartum period is really like a continuation of pregnancy, yet so much research stops at the time of delivery,” says Samantha Parker Kelleher (SPH’14), associate professor of epidemiology and a co-lead investigator of the study, along with Liberty Reforma, a maternal fetal medicine physician at BMC; Idalis Chestnut (SPH’22), project coordinator in the Department of Epidemiology; and Christina Yarrington, former maternal fetal medicine physician at BMC who was instrumental in the development of the study and who now practices maternal fetal medicine at the University of New Mexico School of Medicine.
Aside from cross sectional surveys and limited data from electronic health records, there are few opportunities for systematic data collection on postpartum physical and mental health challenges, Kelleher says.
“Now we will be able to collect primary data from postpartum people about their experiences in real time on a number of important factors, such as breastfeeding, sleep, physical activity, nutrition, and stress—and then we can link this data to their health records to see whether these experiences contribute to certain adverse health outcomes.”
The study is funded by SPH’s Established Investigator Innovation Award, a pilot award that Kelleher received to further her work on perinatal health outcomes, including the long-term risks of pregnancy to maternal health. The team is particularly interested in learning about the clinical and social factors that could be contributing to the risk of maternal cardiovascular disease. Previous studies by Kelleher and Yarrington have shown that 1 in 10 pregnant people develop hypertension—a key early indicator of cardiovascular disease risk—for the first time after pregnancy, and also that 1 in 3 people without prepregnancy cardiovascular disease risk may experience other adverse pregnancy outcomes, putting them at elevated risk of cardiovascular disease.
“Pregnancy and the postpartum period are a window into future health,” says Reforma, who is also an assistant professor of obstetrics & gynecology at BU Chobanian and Avedisian School of Medicine. “With more data comes a better understanding of how we can optimize overall health in between pregnancies, during pregnancies, and in the long term.”
To start, the team plans to enroll 50 BMC patients ages 18 or older who have delivered their baby at BMC and are between four and eight weeks postpartum at the time they complete their first PLACES survey. Each participant will receive two 10-minute surveys to complete around 6 weeks and 12 weeks postpartum. The surveys include a range of questions about patients’ physical and mental health, as well as questions about housing instability, food insecurity, transportation issues, and financial struggles.
With surveys available in English, Spanish, and Creole, the researchers will be able to harness data reflecting the racial, ethnic, and cultural diversity of patients at the largest safety net hospital in New England.
Collecting data during this critical period could also provide new insight into why the US continues to maintain the highest maternal mortality rate among all high-income countries, with stark racial and ethnic disparities. Past research indicates that more than half of maternal deaths occur up to one year after delivery racial disparities in US maternal mortality persists, even with the lower overall rate.
In the future, the researchers say they would consider expanding the study to other hospitals or institutions and extend the follow-up period with patients to six months or longer, as the postpartum period can last up to a year after delivery.
“The postpartum period can be difficult to prepare for because it is so unpredictable,” Kelleher says, adding that postnatal experiences can differ not only from person to person, but from pregnancy to pregnancy. “This is a huge opportunity to collect information on a population that otherwise has infrequent touchpoints with the healthcare system.”
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