Breastfeeding and Postpartum Cardiovascular Health (sheMATTERS)
Hypertensive Disorder of Pregnancy, Pregnancy Complications, Pre-Eclampsia
About this trial
This is an interventional prevention trial for Hypertensive Disorder of Pregnancy
Eligibility Criteria
Inclusion Criteria:
- Age >18 years.
- Singleton live birth delivered at >34 weeks gestation.
- Mother intends to breastfeed (randomized portion)
- Breastfeeding initiated before postpartum hospital discharge (randomized portion)
- Participant speaks and understands English or French.
- Participant has a valid Medicare card (RAMQ, OHIP) at time of recruitment.
- Participant has access to a cellular telephone to receive text messages and install a Blood Pressure Monitoring Application, and internet access to receive emails and to complete online questionnaires.
- Be available to attend in-person visits if COVID restrictions allow (resides in Montreal, Kingston or surrounding areas)
Have AT LEAST ONE OR MORE of the criteria listed below related to the diagnosis of HDP:
i. Pregnancy at or beyond 20 weeks gestation with: Two (2) recorded seated BPs taken at least 15 minutes apart during one medical visit measuring >140 mmHg systolic AND/OR >90 mmHg diastolic AND Recorded elevated BP is present at more than one consecutive medical visit ii. Women who during antenatal visits were prescribed antihypertensive medication, OR received a diagnosis of chronic or gestational hypertension iii. Women who during labor and delivery, had two (2) or more BP measurements >140 mmHg systolic or >90 mmHg diastolic at least 15 minutes apart or who were prescribed antihypertensive medication iv. Women who during labor and delivery received a diagnosis of preeclampsia v. Women with new-onset hypertension as defined above, and/or preeclampsia and/or pre-existing hypertension readmitted within 1 week of postnatal hospital discharge with elevated blood pressure.
Exclusion Criteria:
Exclusion criteria from randomized trial portion of the study:
- Maternal absolute contraindication to breastfeeding (e.g., mother taking medication for which breastfeeding is contraindicated , or mother is infected with human immunodeficiency virus, HTLV-1, active tuberculosis, active herpes simplex on the breast, or Ebola, or mother is a cocaine or phencyclidine user).
- Maternal condition that interferes with breastfeeding (e.g., breast reduction, or breast augmentation surgery due to hypoplastic mammary tissue. Uncomplicated breast augmentation surgery is not an exclusion criterion).
- Neonatal absolute contraindication to breastfeeding (Galactosemia)
- Neonatal condition that interferes with breastfeeding (e.g., cleft palate).
Exclusion criteria from randomized OR observational portion of the study (including non-randomized arm):
- Infant born before 34 weeks gestation.
- Maternal intensive care unit (ICU) admission lasting >24 hours.
- Severe or uncontrolled psychiatric illness in the mother that would preclude active engagement in the study. These include schizophrenia or other psychotic disorder; uncontrolled bipolar disorder; major depressive episode within the last year, or history of major depressive disorder requiring hospitalization at any point; substance abuse disorder; any previous suicide attempt.
- Mother has active COVID-19 infection (confirmed by positive COVID test) at time of postpartum hospitalization.
- Previous BP-MOM participant (ISRCTN85493925, www.isrctn.com)
Sites / Locations
- Kingston General HospitalRecruiting
- Jewish General HospitalRecruiting
- St Mary's HospitalRecruiting
- Muhc-RimuhcRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
No Intervention
No Intervention
Randomized to breastfeeding self-efficacy enhancing intervention with nurse
Randomized to usual postpartum care
Non-randomized observational arm
Participants receiving breastfeeding self-efficacy enhancing nurse-led intervention plus postpartum standard of care consisting of postpartum medical visits with their obstetrics care provider and for cardiovascular risk assessment, routine postpartum hospital breastfeeding support, as-needed community breastfeeding support, and postpartum medical visits with their obstetrics care provider and for cardiovascular risk assessment.
Participants receiving postpartum standard of care consisting of postpartum medical visits with their obstetrics care provider and for cardiovascular risk assessment, routine postpartum hospital breastfeeding support, as-needed community breastfeeding support, and postpartum medical visits with their obstetrics care provider and for cardiovascular risk assessment.
Participants who are not planning to breastfeed receiving postpartum standard of care consisting of postpartum medical visits with their obstetrics care provider and for cardiovascular risk assessment.