Improving heart health to save lives during and after pregnancy Washington University School of Medicine in St. Louis

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Community-based approach in St. Louis and Nigeria supported by NIH grant

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Although the United States and Nigeria are separated by an ocean, infant and maternal mortality rates in the year after childbirth are distressingly high. The Centers for Disease Control and Prevention (CDC) estimates that the U.S. maternal mortality rate will reach nearly 33 deaths per 100,000 births in 2021, about 10 times higher than the death rate in several other high-income counties. In Nigeria, the situation is even worse: 530 deaths per 100,000 births, according to the World Health Organization.

To reduce these numbers and save lives, researchers at Washington University in St. Louis and the University of Abuja in Abuja, Nigeria, received grants to partner with community-based organizations in St. Louis and Abuja, both of which work with parents as teachers, U.S. A national organization that has long provided support to young families through home visits. These programs build on existing home visiting models and aim to improve the cardiovascular health of the mother during pregnancy and after delivery for the entire family. The funding comes from two National Institutes of Health (NIH) grants totaling $9 million.

Nigeria has one of the highest maternal mortality rates in the world, said cardiologist Mark Hoffman, MD, professor of medicine and co-director of the University of Washington Center for Global Health. In the United States, Missouri also has high mortality rates during and shortly after pregnancy. Many of these deaths are due to hypertensive disorders of pregnancy, especially high blood pressure, which can lead to heart failure, seizures, stroke and death. Sadly, these conditions are often preventable. We know what is effective in lowering blood pressure, and the programs we are developing here and in Nigeria aim to make these interventions available to those who need them most.

These programs will help families manage cardiovascular health and incorporate healthy eating, physical activity, stress management, sleep and tobacco prevention information and activities into “Parents as Teachers” curricula. The teams aim to help participants manage other risk factors for cardiovascular disease, including weight, blood pressure and blood sugar during and after pregnancy. Researchers will track the family’s progress, continuing home visits and collecting data until the children are 2 years old.

“We are taking a multigenerational approach to improving family cardiovascular health through interventions that target pregnancy and early childhood,” said cardiologist Victor Davila-Roman, MD, professor of medicine, anesthesiology, and radiology at the School of Medicine. Davila-Román also serves as director of the Center for Global Health, a joint effort between the Institute of Public Health and the University of Washington Department of Medicine.

In St. Louis, the “Enhancing Equity in Cardiovascular Health for Mothers and Children through Home Visiting” project is led by principal investigator Debra Haire-Joshu, Ph.D., Joyce and Chauncy Buchheit, professor of public health at Washington University, and Davila-Roman and Rachel Tabak, Ph.D., Brown School Associate Professor. The UW program is part of the National Institutes of Health’s Early Intervention to Improve Maternal and Child Cardiovascular Health (ENRICH) program, one of seven clinical centers funded across the United States that are conducting similar work.

In Nigeria, the newly funded project Enhancing Intergenerational Health in Nigeria: The Perinatal Period as a Critical Life Stage for Cardiovascular Health (ENHANCE-CVH) is led by principal investigator Huffman, who has long-standing collaborations with colleagues at the University of Abuja; Davila-Roman; Dike Ojji, MBBS, PhD, associate professor and head of the Department of Internal Medicine, University of Abuja; Godwin Akaba, MBBS, associate professor and obstetrician-gynecologist, University of Abuja.

“We are excited about these two projects because they promise to be so interactive,” Haire-Joshu said. We will have many opportunities to learn from each other about the best ways to teach new young families about cardiovascular health. We expect the new strategies we learned in Abuja to apply to St. Louis and vice versa. This is a perfect example of collaboration between communities in St. Louis and around the world interested in building local to global and back again.

Dike Ojji from the University of Abuja added: “This program is important because risk factors such as cardiovascular disease and hypertension are the most common causes of death and morbidity during pregnancy in Nigeria and across Africa.” We hope that this program will be supported by the Federal Ministry of Health as it is in line with Nigeria’s policy to reduce maternal and fetal morbidity and mortality.

In St. Louis and Nigeria, researchers are working with Parents as Teachers, a national organization founded in St. Louis. Trained professionals use parents as teachers to support young families through regular home visits during pregnancy and early childhood, with the aim of working with parents to support their children’s development; to support positive interactions between parents and children; to improve parenting practices; to improve children’s and families’ school readiness; and improving family, caregiver, and child health, among other goals.

Past research involving this program has shown that home visits to young families help them develop healthy habits that promote early childhood development. The hope is that adding the latest heart health science to existing approaches will create new habits that will improve cardiovascular health for the entire family. Once established, these habits can ultimately improve the health of your children and grandchildren as well.

The partnership between Washington University and the PTA goes back about 25 years, said Allison Kemner, senior vice president and chief research officer of the St. Louis-based Parent Teacher National Center. Through this latest partnership, we are taking health interventions that aid weight control and diabetes management and integrating them into our existing Parents as Teachers programme. When UW brings science and parents as teachers to bring practice into homes, they can have a powerful impact.

In Nigeria, researchers will adapt an intervention developed with Parents as Teachers in St. Louis and implement it in Abuja, training community health workers and nurses who serve as community health educators to deliver heart health messages during regular home visits.

The program will focus on families at the highest risk for cardiovascular disease burden, including Black and Hispanic families in St. Louis, socioeconomically disadvantaged families, families affected by obesity, and families with parents with an elementary school education or less.

This work was supported by the National Institutes of Health (NIH) under grant numbers UG3HL162970 and R01HL168771. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

About Washington University School of Medicine

Washington University School of Medicine is a global leader in academic medicine, including biomedical research, patient care and education programs, with 2,800 faculty members. Its National Institutes of Health (NIH) research funding portfolio ranks third among U.S. medical schools, having grown 52% over the past six years, and combined with institutional investment, Washington University School of Medicine invests more than $1 billion annually in basic and clinical research USD innovation and training. Its faculty is consistently ranked among the top five in the nation, with more than 1,800 faculty physicians practicing at 65 locations who also serve on the medical staff of BJC HealthCare’s Barnes-Jewish Hospital and St. Louis Children’s Hospital. Washington University School of Medicine has a long history of MD/PhD training, recently investing $100 million to provide scholarships and curriculum updates for its medical students, and in every medical subspecialty as well as physical therapy, occupational therapy and audiology Both have first-rate training programs and communications science.


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