Predicting Complications Postpartum

A relevant cardiac health trend is the United States’ growing maternal mortality rate — the worst among industrialized countries. The majority of maternal deaths occur postpartum and result from hypertensive disorders like preeclampsia and gestational hypertension.

Alisse Hauspurg, MD, assistant professor of obstetrics, gynecology, and reproductive sciences at Pitt’s School of Medicine, is the lead investigator on the NIH R21 Trailblazer Award entitled, “Development of a smartphone-based device to detect fluid overload among postpartum women with hypertensive disorders of pregnancy.” Ramakrishna Mukkamala, PhD, professor of bioengineering at Pitt’s Swanson School of Engineering and professor of anesthesiology and perioperative medicine at Pitt’s School of Medicine is a co-investigator on this award that uses arterial waveforms to predict fluid buildup in patients with preeclampsia. McGowan Institute for Regenerative Medicine faculty member Sanjeev Shroff, PhD, distinguished professor and Gerald E. McGinnis Chair of bioengineering, and Aman Mahajan, MD, PhD, Peter and Eva Safar Professor and chair of anesthesiology and perioperative medicine and professor of bioengineering, will also collaborate on the project.

“A subset of women with high blood pressure in pregnancy develop fluid overload and heart failure symptoms postpartum, which can lead to an increased risk of hospital readmission and significant complications after delivery,” explained Dr. Hauspurg.

“Home blood pressure monitors improve manageability of hypertension,” Dr. Mukkamala said, “but they do not reduce the incidence of postpartum hospital readmission related to fluid overload.”

The team will develop a smartphone-based device for convenient monitoring of postpartum fluid overload. Such a device could indicate which patients should receive more aggressive treatment prior to discharge and may potentially save the life of a new mother.

The project abstract follows:

Hypertensive disorders of pregnancy contribute to a significant proportion of maternal morbidity and mortality and are the most common reason for hospital readmission postpartum. While treatment of hypertension is the cornerstone of postpartum management, emerging evidence suggests that implementation of robust remote blood pressure monitoring and treatment programs alone do not reduce maternal morbidity or hospital readmissions related to postpartum fluid overload and heart failure symptoms. The ability to predict which women will develop these complications and pursue more aggressive treatment with diuresis prior to hospital discharge or in the first week postpartum is limited. The overall goal of this line of research is to develop and implement a convenient congestion prediction device for home use in conjunction with home blood pressure monitoring in a postpartum population following a hypertensive disorder of pregnancy. In this application, the objective is to develop and test a smartphone-based device to predict fluid overload in patients with preeclampsia through three specific aims: 1) to build multiple smartphone-based devices to assess volume status via a congestion prediction index in postpartum women with preeclampsia, 2) to collect patient training data with the devices, optimize their accuracy in assessing volume status, and identify and create the final real-time device and 3) to validate the final device prospectively in response to known fluid changes among a new cohort of postpartum women with preeclampsia. The research proposed in this application is innovative in its novel adaptation of evidence-based approaches to fluid assessment in heart failure patients to an understudied postpartum population with significant morbidity, its use of a smartphone form factor and the design and the proposed testing of multiple devices to optimize effectiveness and convenience. This proposal is significant as it will provide an opportunity to develop and assess the feasibility of smartphone-based assessment of fluid status among postpartum women with preeclampsia. Effective interventions to improve postpartum hypertension care coupled with innovative remote strategies have broad implications for improving maternal morbidity and reducing disparities in care. Our findings will provide a valuable framework to inform a future randomized trial of remote assessment and management of fluid status in the postpartum period. Successful completion of this line of research would represent a transformation in postpartum management of women with preeclampsia and have a direct impact to improve hypertension and cardiovascular-related maternal morbidity and mortality.