Current research being done by the Obstetric Medicine Research Group at St George Hospital, Sydney.
Postpartum Physiology, Psychology and Paediatric (P4) follow-up Study
The P4 Study is investigating the physical and mental health of women, and the health and development of their children, at 6 months, 2 years and 5 years following the birth. Comparisons will be made between women who had normal blood pressure in pregnancy and those who had either gestational hypertension or preeclampsia. For the women, the study provides a health check-up at each study time-point. This check-up includes blood pressure measurements using three different devices, body composition measurement, blood and urine tests. Some women will have a cardiac echogram (heart ultrasound). There are also questionnaires to complete about physical and mental health. The child has a general health check-up with a paediatrician at each time-point as well as a formal assessment of their development when two years old, done by a child psychologist.
415 women have been recruited to the study (302 normal, 23 GH, 90 PE); recruitment is now closed. The 6 month and 2 year visits have finished and the team is working through the 5 year visits. All study visits will be completed December 2023.
Blood Pressure Postpartum (BP2) Study
The BP2 Study follows on from the P4 Study and aims to compare the effect of three different follow-up pathways for women who experienced a hypertensive disorder of pregnancy (pre-existing hypertension, gestational hypertension or preeclampsia), on women’s blood pressure and positive lifestyle behaviour change. The women are randomly allocated one of these pathways and a health check-up is done at 6 months and 12 months following the birth of their baby (longer follow-up is planned if more funding is secured). Comparisons will be made between the 6 month and 12 month results to see if one group made more positive lifestyle changes and improvements in their health; measured by change in weight, blood pressure, waist measurement, cholesterol, physical activity and dietary changes. The three groups are:
Group 1. Optimised Usual Care: Women see their GP 6 months after having their baby, for a discussion about high blood pressure in pregnancy and the long term risks, and measurements are taken. An information package is sent to the women and her GP.
Group 2. Brief Education Intervention: One-off heart health and risk assessment by a doctor and diet/exercise education given by a dietitian in a dedicated clinic 6 months after the baby is born. An information package is sent to the women and her GP.
Group 3. Extended Lifestyle Intervention: One-off heart health and risk assessment by a doctor and diet/exercise education given by a dietitian in a dedicated clinic 6 months after the baby is born, followed by an individualised dietary and exercise lifestyle program of six months duration (Get Healthy Service An information package is sent to the women and her GP.
The BP2 Study is being carried out at six Sydney hospitals (Campbelltown, Liverpool, Royal Hospital for Women, Royal Prince Alfred, St George and Westmead) and is currently recruiting at all sites. The Research Team aim to recruit 500 women to the study, currently there are 300 women taking part.
Assessing women’s and healthcare provider’s knowledge gaps and education preferences regarding health after hypertensive disorder of pregnancy
This study assessed knowledge and knowledge gaps about women’s health after a hypertensive disorder of pregnancy (pre-existing hypertension, gestational hypertension, and preeclampsia). Information was collected from women and healthcare providers through national surveys and via interviews.
266 women completed the survey and 13 participated in an interview. The survey identified that women had high knowledge with regards to future risk of high blood pressure and high blood pressure in future pregnancies. Lower knowledge was identified regarding increased risk of heart disease, stroke, and diabetes. Women wanted more detailed information about long-term health risks and they suggested counseling from their healthcare provider early on after birth along with printed or web-based information to take home. Link to the publication regarding women’s survey results: https://bmjopen.bmj.com/content/10/12/e042920
492 health care providers (midwives, obstetricians, general practitioners with specialist training in obstetrics/gynecology, and cardiologists) completed the survey. Most were aware that there is an increased risk of heart disease after high blood pressure in pregnancy and knowledge was high regarding the risk of high blood pressure in future pregnancies and later in life. The healthcare providers suggested a web-based information hub and a more structured referral process after discharge from maternity services including a follow-up plan for GPs and women to follow after high blood pressure in pregnancy. Link to our publication regarding healthcare provider survey results: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03418-5
As a follow-on from this study, we are planning a pilot study to assess the usefulness and acceptability of an education package and follow-up system for women who have had high blood pressure in pregnancy. The study is supported by a Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Maternal, Newborn and Women’s Clinical Academic Group grant.