Collaboration Between Maternal and Child Health and Chronic Disease Epidemiologists to Identify Strategies to Reduce Hypertension-Related Severe Maternal Morbidity.

Ghasi Phillips-Bell,Abigail Holicky,Rahel Dawit,Leticia Hernandez,Angel Watson,Megan Macdonald

doi:10.5888/pcd16.190045

Abstract

IntroductionMaternal and child health (MCH) and chronic disease programs at state health agencies may not routinely collaborate. The objective of this study was to describe a project that enhanced relationships between MCH and chronic disease epidemiologists at the Florida Department of Health, increased epidemiologic capacity, and informed both programs.MethodsWe collaborated to assess hypertension-related severe maternal morbidity (H-SMM) and hypertensive disorders (preexisting hypertension, gestational hypertension, and preeclampsia) among women at delivery of their live birth to help determine the burden on health care systems in Florida. We identified ways to improve the health of women before they conceive and to help them manage any chronic diseases during the perinatal period.ResultsWe found differences by maternal characteristics in H-SMM rates among 979,660 women who delivered live births. We proposed strategies to support collaboration between state MCH and chronic disease staff. First, increase the screening, monitoring, and management of hypertension before, during, and after pregnancy. Second, examine H-SMM concurrently with maternal mortality to help find prevention strategies. Third, include reproductive-aged women in ongoing hypertension prevention and intervention efforts. Fourth, expand team-based care to include obstetricians, midwives, and doulas who can work together with primary care providers for hypertension management. And fifth, create and share data products that guide various groups about hypertension and related risk factors among reproductive-aged women.ConclusionThe collaboration between the Florida Department of Health MCH and chronic disease epidemiologists produced 1) a program-relevant indicator, H-SMM and 2) strategies for enhancing program and clinical activities, communication, and surveillance to reduce H-SMM rates.

Highlights

Maternal and child health (MCH) and chronic disease programs at state health agencies may not routinely collaborate
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We investigated median hospital length of stay, median hospital charges, and hypertension-related severe maternal morbidity (SMM) (H-SMM) rates, and whether these differed by type of hypertensive disorder, to help identify the burden each disorder places on health care systems in Florida

Summary

Introduction

Maternal and child health (MCH) and chronic disease programs at state health agencies may not routinely collaborate. The objective of this study was to describe a project that enhanced relationships between MCH and chronic disease epidemiologists at the Florida. Maternal and child health (MCH) and chronic disease epidemiologists may not routinely work together at state health agencies. Possible reasons include organizational structures that preclude effective communication and a limited understanding of how MCH and chronic disease morbidity intersect [1]. Women with chronic conditions, such as diabetes or obesity, have an increased risk of preeclampsia [2], a pregnancy-specific hypertensive disease that involves several body systems and typically starts after the 20th week of pregnancy [3]. Addressing topics that cross both disciplines, such as severe maternal morbidity (SMM), requires expertise in both MCH and chronic disease

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