Melissa Daubert, MD, assistant professor of medicine (Cardiology), has received one of four 2018 Carolinas Collaborative Grant awards to examine the postpartum care received by pregnant women with hypertensive disorders.
“From retrospective studies, we know that hypertensive disorders during pregnancy put women at higher risk for cardiovascular events later in life,” Daubert said. “If we screen for these early markers for future disease and treat them appropriately, we have the potential to change the trajectory for these patients.”
The $50,000 grant, administered by the North Carolina Translational and Clinical Sciences Institute, calls for applicants to collaborate with researchers from other institutions to use resources from the Carolinas Collaborative. The Collaborative harmonizes electronic health record data across Duke, the University of North Carolina at Chapel Hill, the Medical University of South Carolina, and Wake Forest University.
Daubert, the principal investigator, will work with co-investigators in cardiology and obstetrics-gynecology at Duke (Tracy Wang, MD, associate professor of medicine (Cardiology), and Thomas Price, MD, professor of obstetrics and gynecology) and UNC-Chapel Hill (Rachel Urrutia, MD, MS, and Paula Miller, MD). The team will study women with hypertensive disorders of pregnancy who received treatment from Duke and UNC between January 2007 and June 2018. Preliminary results show that over 10,000 women have experienced a hypertensive disorder of pregnancy, which is about 14 percent of all pregnancies that received care at Duke and UNC-Chapel Hill during this time period.
“The national average for the proportion of pregnancies in which the mother has a hypertensive disorder is 10 percent, so these complications are particularly prevalent in our region,” Daubert said. “That makes this study especially important to figure out how best to care for this high-risk population of women and devise interventions to reduce their future cardiovascular risk.”
In North Carolina, many patients transition between Duke and the University of North Carolina Health Care Systems for their primary and specialty care needs. The collaborative nature of the study is also important, Daubert said, because if the research team looked at records from only one institution, there would be a high likelihood of missing follow-up care or treatment for women who saw providers at both Duke and UNC. Because the Carolinas Collaborative has coded electronic health records so that they can be viewed simultaneously across institutions, she said, it was the perfect opportunity to answer this research question.
Guidelines from the American Heart Association advise that women who have hypertensive disorders during pregnancy should be screened six to 12 months after giving birth. Daubert and her team will look at how consistently this screening is being carried out, as well as which types of providers are conducting the screening. They will also compare outcomes of women who received screenings and women who did not.
“While there is growing awareness that these hypertensive disorders increase risks down the road, this correlation is still often unrecognized by patients and providers,” Daubert said. “There is also a misconception that the cardiovascular events will occur decades later, but in reality, up to 45 percent of women who have hypertensive disorders during pregnancy will develop overt hypertension that needs treatment within five years of giving birth.”