JAMA Netw Open. 2026 Aug 3;9(8):e2626970. doi: 10.1001/jamanetworkopen.2026.26970.
ABSTRACT
IMPORTANCE: Hypertensive disorders of pregnancy (HDP) affect 10% to 16% of US pregnancies and increase the risk of developing cardiovascular disease. Guidelines recommend that individuals who experience this diagnosis attend a primary care visit within 12 months post partum to evaluate and manage cardiovascular health.
OBJECTIVE: To evaluate the preliminary effectiveness of a postpartum health coaching intervention in improving health care engagement and blood pressure (BP) control among individuals with hypertension during pregnancy.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from February 2023 to April 2025 at a community hospital in the Midwestern US. Eligible participants were postpartum women aged 18 years or older with an HDP diagnosis who met one of the following criteria: (1) confirmed diagnosis of chronic hypertension (high BP [≥130/80 mm Hg] before pregnancy or before 20 weeks' gestation), (2) continued use of antihypertensive medications at 6 weeks post partum, and (3) persistent uncontrolled hypertension not managed with antihypertensive drugs (≥130 and/or ≥80 mm Hg) at 6 weeks post partum. All participants completed a remote BP monitoring program. Participants were randomly assigned to receive a health coaching intervention (Staying Healthy After Childbirth-My Hypertension Education And Reaching Target Post Partum; intervention group) or standard of care (control group). The primary analysis followed the intention-to-treat principle.
INTERVENTION: Participants in the intervention group performed self-measured BP monitoring and received telephone calls from a health coach biweekly for 2 to 6 months post partum and then monthly for 6 to 12 months post partum. Participants were encouraged to create health goals and were supported in their efforts with evidence-based health information. Coordination of care with the participant's primary care physician occurred as needed. Participants in the control group received usual care as indicated by their designated clinician.
MAIN OUTCOMES AND MEASURES: The primary outcome was attendance at a primary care visit by 12 months post partum. Secondary outcomes included BP control (<130/<80 mm Hg) and engagement in health-promoting behaviors, such as eating a healthy diet and exercising, by 12 months post partum.
RESULTS: A total of 140 postpartum participants were randomly assigned 1:1 to the intervention group (n = 70; mean [SD] age, 33.4 [5.0] years) or control group (n = 70; mean [SD] age, 33.3 [5.1] years). Two participants had missing primary outcome data. At the time of trial enrollment, 44 participants (63.8%) in the control group and 40 (57.1%) in the intervention group were using an antihypertensive medication. At 6 weeks post partum, the mean (SD) self-measured systolic BP and diastolic BP measurements were 118.8 (8.3) mm Hg and 78.9 (6.9) mm Hg, respectively, in the control group and 119.0 (9.6) mm Hg and 79.3 (7.3) mm Hg, respectively, in the intervention group. Primary care visit attendance was significantly higher in the intervention group than the control group (49 of 69 [71.0%] vs 27 of 69 [39.1%]; relative risk [RR], 2.00 [95% CI, 1.34-2.97], P < .001). The intervention group also demonstrated greater reductions from baseline to 12 months post partum in systolic BP (mean difference, -5.6 [95% CI, -9.4 to -1.7] mm Hg, P = .005) and diastolic BP (mean difference, -4.5 [95% CI, -7.7 to -1.3] mm Hg, P = .006). BP control (<130/80 mm Hg) was significantly more likely among the participants in the intervention compared with the control group (26 of 47 [55.3%] vs 19 of 61 [31.1%]; RR, 1.73 [95% CI, 1.13-2.66]; P = .02). No significant differences in health behaviors were observed between groups.
CONCLUSIONS AND RELEVANCE: The health coaching intervention combined with self-measured BP monitoring significantly increased health care engagement and BP control by 12 months post partum. These findings support health coaching as an effective strategy for reducing long-term uncontrolled hypertension among patients with HDP.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05685251.
PMID:42566217 | DOI:10.1001/jamanetworkopen.2026.26970