# System factors influencing the postpartum transition to primary care for cardiovascular disease risk management among women with hypertensive disorders in pregnancy

> **NIH NIH R01** · BAYSTATE MEDICAL CENTER, INC. · 2024 · $236,799

## Abstract

PROJECT SUMMARY
Cardiovascular disease (CVD) is the leading cause of death among women in the United States, and Black
women have higher rates of CVD mortality than White women. Women who experience hypertensive disorders
in pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia/eclampsia,
face substantially higher future CVD risk. About one in seven women experience HDP by the end of their
childbearing years, with higher rates among women of color. HDP is an important sex-specific risk-enhancer
for CVD as a history of HDP imparts a similar increase in CVD risk as smoking cigarettes or having a family
history of CVD. Transitioning to primary care postpartum is recommended for all women but has particular
urgency for women with HDP. Primary care is an appropriate setting for short- and long-term CVD risk
management, including identification and treatment of hypertension and hyperlipidemia. However, little is
known about the primary care provided for postpartum women with HDP and whether it responds to their
heightened CVD risk. Prior research has shown substantial disparities in rates of postpartum primary care use
by insurance status and by race/ethnicity, and in the care delivered immediately postpartum, but little is known
about clinical care delivered in postpartum primary care after experiencing HDP for CVD risk management and
whether women of color and publicly insured women receive different care. Our parent grant (NHLBI
R01HL164489-02) uses a mixed methods design to examine the postpartum transition to primary care and the
CVD risk management provided within primary care for women with recent HDP. This administrative
supplement will allow us to enhance our ongoing research with additional detail on intersectional patient-level
factors to examine whether these systems of care disproportionately contribute to disadvantage for women of
color and women with lower incomes. In response to NOT-OD-24-032, we propose to enhance Aim 2 of our
parent grant by using a clinical records database to (2A) examine the association of clinician patient panel
characteristics (minority-serving, Medicaid-serving) and CVD risk management in postpartum primary care,
and (2B) to determine whether associations in 2A vary by individual patient characteristics (race/ethnicity,
insurance type). This proposed supplement addresses how inequities in healthcare may contribute to poor
CVD outcomes for women with multiple marginalized identities. Our research team will include both early
career and independent investigators with appropriate expertise in maternal and women’s health, health
inequities among minoritized groups, and clinical care responsive to heightened CVD risk. The proposed
supplement research is important because as rates of HDP rise nationally and racial disparities in HDP persist,
appropriate management of CVD risk may mitigate impact on future CVD outcomes, including premature
mortality.

## Key facts

- **NIH application ID:** 11019294
- **Project number:** 3R01HL164489-03S1
- **Recipient organization:** BAYSTATE MEDICAL CENTER, INC.
- **Principal Investigator:** Laura B Attanasio
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $236,799
- **Award type:** 3
- **Project period:** 2023-04-15 → 2028-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11019294

## Citation

> US National Institutes of Health, RePORTER application 11019294, System factors influencing the postpartum transition to primary care for cardiovascular disease risk management among women with hypertensive disorders in pregnancy (3R01HL164489-03S1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/11019294. Licensed CC0.

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