Improving care for women with high blood pressure in pregnancy to reduce future risk of heart disease.

Abstract

Hypertensive disorders of pregnancy (HDP) are associated with increased risk of future cardiovascular disease and widening health inequalities, and are more prevalent in women of Black African and Caribbean heritage. Previous studies have highlighted the importance of patient education and lifestyle modification for cardiovascular risk reduction, yet awareness of increased risk remains low among healthcare professionals, and studies exploring patient and healthcare professional perspectives regarding risk reduction are lacking. This qualitative research aimed to explore lived experiences, perspectives and needs of global majority women with HDP and perspectives of healthcare professionals (HCPs) to develop a model for self-care and cardiovascular risk reduction and reduce health inequities. Following ethics approvals, women with HDP and HCPs managing pregnant/postnatal women were recruited through healthcare and community networks. Semi-structured interviews were conducted online or by telephone with informed consent. Qualitative data were analysed iteratively. This study had input from a Patient and Public Involvement and Engagement (PPIE) group throughout. Inductively developed themes include women's limited knowledge of risk factors for heart disease and association with HDP; anxiety regarding health, impact on future pregnancies and work disruption. HCPs reported that they were unaware of increased cardiovascular risk and NICE HDP guidance. All participants emphasised the importance of education and/or information to increase awareness. A Community of Practice and the PPIE group will co-design a framework for self-care. The study will contribute to the implementation of NICE HDP guidance, develop a model of care for cardiovascular risk reduction and reduce health inequalities.