Nutrition Optimization and Community Upliftment for Postpartum Recovery: Hypertension

Johns Hopkins University

Overview

The goal of this clinical trial is to better understand how different strategies, timing, and enhancements to medically tailored food delivery will address structural inequities in the food environment, empower communities to sustain behavior change, and ultimately improve postpartum weight control to prevent chronic hypertension-a potent contributor to disparate mortality among Black women. * To conduct a pilot randomized control trial to test the feasibility, acceptability, and effectiveness of a multi-component Medically Tailored Food (MTF) intervention, MFeast ENHANCED (a hybrid MTF intervention with a patient-activated change from prepared meals to fresh food delivery, customized for postpartum people, culturally customized for engagement and adherence, and food provision for dependents) versus MFeast Usual Care (prepared medically tailored foods only). * To test sustainability and scalability. Participants will: * Respond to online surveys (supported by study team members via scheduled phone calls) via REDCap links shared before each study visit at baseline, 3 and 6 months post-delivery after the baseline survey. * Submit anthropometric data (e.g. weight and blood pressure)

This study will evaluate the feasibility, acceptability, and preliminary effectiveness of a postpartum dietary intervention for Black women with obesity and a recent pregnancy complicated by hypertensive disorders of pregnancy (HDP). The investigators will recruit women through Medicaid insurance plans (Priority Partners), clinical obstetric practice (Johns Hopkins Outpatient Center, Women's Health Center), perinatal community-based organizations (MOM Cares and Bloom Collective), and home-visiting locations (The Family Tree of Maryland)-all of which can verify clinical outcomes for participants. At 37 weeks gestation, participants are contacted by the study team for consent, baseline data collection (baseline visit 1), and randomization 1:1 to receive the intervention vs. usual care (which begins in the first postpartum week). 3-7 days after randomization, the remainder of baseline visit information (baseline visit 2) is collected including information for prepared MTF food supplier Moveable Feast Baltimore. The intervention group will initially receive 10 weekly prepared heart-healthy meals from MFeast; Lactation nutritional snack bundles to boost milk supply + structural support for breastfeeding/ pumping via lactation consultants and pumping supply subsidization; culturally-adapted seasoning bundles; and dependent meal boxes for children in the household (i.e., will include 10 developmentally appropriate snack and small meal bundles, for up to 24 weeks. At postpartum week 8 participants will be offered a transition from prepared medically tailored meals to Instacart fresh food delivery (medically tailored via study team-crafted virtual grocery store) for 16 more weeks. Those assigned to the "MFeast Usual Care" group will receive 10 weekly prepared heart-healthy meals from Moveable Feast (MFeast).

Interventions

MFeast ENHANCEDBEHAVIORAL

The intervention group will initially receive 10 weekly prepared heart-healthy meals from MFeast; Lactation nutritional snack bundles to boost milk supply + structural support for breastfeeding/ pumping via lactation consultants and pumping supply subsidization; culturally-adapted seasoning bundles; and dependent meal boxes for children in the household (i.e., will include 10 developmentally appropriate snack and small meal bundles, for up to 24 weeks. At postpartum week 8 participants will be offered a transition from prepared medically tailored meals to Instacart fresh food delivery (medically tailored via study team-crafted virtual grocery store) for 16 more weeks.

MFeast Usual CareBEHAVIORAL

Those assigned to the "MFeast Usual Care" group will receive 10 weekly prepared heart-healthy meals from MFeast.

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥18 years * Self-identify as Black or African American * Low-income (defined as eligible for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits) * Speak English as a primary language * Identify as a primary meal planner/preparer * Hypertensive disorder of pregnancy, defined as one of the following: Gestational Hypertension, Preeclampsia, Eclampsia * Gestational Age \>37 weeks * Have a BMI \> 30 (calculated based on chart review of height and weight measurement) * Willing to take part in the intervention and data collection procedures through online surveys Exclusion Criteria: * Mothers who have social support i.e. have family members preparing meals for the mother * Mothers who are unlikely to be at the primary residence in the postpartum period * Mothers with very specific dietary needs, i.e, food allergies, picky eaters, vegetarian/vegan * Mothers whose birth outcome is a stillborn * Mothers who have serious mental illness

Outcomes

Primary Outcomes

Participant Enrollment Rate

Participant Enrollment Rate as assessed by the percentage of participants consented/enrolled compared to the total eligible participants.

Time frame: 6-8 months postpartum

Participant Retention

Participant Retention as assessed by the percentage of participants completing all study follow-up visits among all enrolled participants.

Time frame: 6-8 months postpartum

Adherence as assessed by self-reported food consumption scores and photographs

Adherence as assessed by self-reported food consumption scores and photographs sent to the study team via secure messaging app. Food Consumption scores range from 0%, 25%, 50%, 75%, or 100%, indicating the amount of food consumed the prior week (self and dependents scores reported).

Time frame: 6-8 months postpartum

Satisfaction as assessed by focus groups and the 8 item Client Satisfaction Questionnaire- (CSQ-8)

Participants rate satisfaction with the intervention's meal quality, delivery service, and likelihood of recommending the service to others at study completion, to assess the extent to which the intervention met their needs and preferences. Scores range from 8 to 32, with higher values indicating higher satisfaction.

Time frame: 6-8 months postpartum

Participant Engagement assessed by frequency and quality of meal discussions

Analyze the messaging app and Slack Channel to determine the frequency and quality of discussions about meals and recipes.

Time frame: 1-6 months postpartum

Secondary Outcomes

Dietary Quality as assessed by the Healthy Eating Index (HEI) 24-hour recall

The HEI uses a scoring system to evaluate a set of foods. The scores range from 0 to 100. An ideal overall HEI score of 100 reflects that the set of foods aligns with key dietary recommendations and dietary patterns published in the Dietary Guidelines.

Time frame: Baseline, 3 and 6 months postpartum

Stress assessed by the 4-item Stress Scale

The 4-item Stress Scale consists of 4 questions. The lowest total score is 0 and the highest total score is 16. Higher scores are correlated to more stress.

Time frame: Baseline, 3 and 6 months postpartum

Food Insecurity measured using a 6-item Food Insecurity Scale

The 6-item Food Insecurity scale uses a subset of the standard 18 item food security scale. The Scores on the scale range from 0-6 with 0-1 indicating high or marginal food security, 2-4 indicating low food security and 5-6 indicating very low food security

Time frame: Baseline, 3 and 6 months postpartum

Postpartum Weight (pounds) Retention as assessed by the difference in self-reported pre-pregnancy weight and postpartum weights

Will be assessed by calculating the difference in self reported pre-pregnancy weight (with Electronic Health Record validation) and postpartum weights (study provided scales)

Time frame: Baseline, 3 and 6 months postpartum

Nutrition Optimization and Community Upliftment for Postpartum Recovery: Hypertension

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes