Recipient organisationUniversity Hospitals of North Midlands NHS TrustSource-published name: University Hospitals of North Midlands NHS Trust
Funding£220K
PeriodDec 2025 — Mar 2028
In plain English
AI plain-English summary
Women who develop high blood pressure during pregnancy face double the usual risk of cardiovascular disease later in life, yet most are never told about this or offered preventive care. This project will design and test a practical "care bundle"—a set of evidence-based actions for GPs and midwives—to close that gap. The problem is stark: the UK’s NICE guidelines explicitly recommend that women who have had hypertensive disorders of pregnancy discuss cardiovascular risk reduction with their GP, but awareness among both patients and healthcare professionals is near-zero. Current postnatal checks often miss blood pressure measurement entirely, and care varies sharply by ethnicity, age, and socioeconomic status. The team will first identify international best-practice guidelines, then analyse a large UK primary care database to map exactly what care women currently receive and where disparities lie. Working with GPs, nurse practitioners, and women who have lived through these pregnancies, they will co-design a care bundle through consensus meetings. Finally, they will test whether the bundle works in real general practices—can staff deliver it, and do women find it accessible? If successful, the bundle could become a standard part of postnatal care, systematically reducing long-term heart disease risk in a population that is currently overlooked.
View original technical description
Background Hypertensive disorders of pregnancy (HDP) are leading causes of maternal morbidity and mortality worldwide. Postnatally, HDP is associated with a doubling in risk of cardiovascular disease (CVD) and hypertension in later life. The NICE Hypertension in Pregnancy Guideline states "advise women who have had HDP to discuss how to reduce their risk of CVD, including hypertensive disorders, with their general practitioner (GP) or specialist". However, most pregnant women, and healthcare professionals caring for them, are not aware of the CVD risks or the NICE recommendation for risk reduction in HDP. Aim and Objectives We aim to co-design, with stakeholders, a postnatal care bundle to reduce risk of CVD in women who experienced HDP. Our objectives for postnatal women following HDP are to: (a) identify evidence-based guidelines relevant to primary care in the UK, (b) assess current practice and investigate disparities in care, (c) co-design a care bundle, and (d) test operational feasibility and accessibility of the care bundle. Methods This 28-month study consists of 4 stages: 1. A systematic review will be conducted to identify international guidelines for postnatal care following HDP, with input from Patient and Public Involvement (PPI) and clinical advisory group members. Primary research published since guideline development will also be included in the review. The evidence synthesis will provide the evidence base for potential elements for the care bundle. 2. A population-based retrospective cohort study of women diagnosed with HDP will be conducted using Clinical Practice Research Datalink (CPRD) Aurum, a large UK database of routinely collected primary care health records. To assess current practice in postnatal care, descriptive analysis of healthcare utilisation within 12 months of delivery will be performed, including timely 6-8 week postnatal check and blood pressure measurement. We will explore variation by age, ethnicity, race, socioeconomic status, and other factors identified by the clinical advisory and PPI groups. 3. We have separate funding (NIHR206181) to conduct a qualitative study to understand the lived experiences and needs of women with HDP regarding postnatal care and the perspectives of, and challenges faced by, healthcare professionals providing care for women with HDP. Evidence from stage 1, stage 2 and the qualitative study will contribute to the co-design of a postnatal care bundle with a panel consisting of stakeholders (e.g. GPs, nurse practitioners, PPI group members). The panel will participate in three consensus meetings, using Institute for Healthcare Improvement guideline and theory-of-change principles. 4. We will test the care bundle in general practices for operational feasibility and accessibility. We will run pre- and post-intervention workshops for healthcare professionals. We will also conduct a focus group meeting for women. Anticipated Impact and Dissemination Through knowledge sharing and involvement of relevant stakeholders including women with HDP, our care bundle will improve the quality of postnatal care and self-management. We will co-produce a dissemination plan with PPI contributors. Potential dissemination pathways include social media, healthcare professional updates, high-impact journal publications, academic and clinical conferences. We will hold a dissemination event to strategic keynote speakers, stakeholders, and PPI contributors.
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