DAPHNY: Diet and Activity for Pregnancy Hypertension

Aims:

Pregnant women living with chronic hypertension (long-term high blood pressure) may benefit the most from lifestyle modification. The aim of the DAPHNY study was to work with women who have experienced long-term high blood pressure during pregnancy and healthcare professionals to design and develop a digital lifestyle intervention that could support blood pressure management.

Why this is important:

Chronic hypertension, which affects 3-5% of pregnancies, is high blood pressure that exists before pregnancy or before 20 weeks gestation. Women who enter pregnancy with chronic hypertension are at increased risk of pregnancy and birth complications. Lifestyle factors including a nutrient-dense diet and adequate physical activity levels play a vital role in cardiovascular disease progression through well-evidenced sustained and clinically relevant reductions in blood pressure.

Supporting women with complicated pregnancies to adopt healthy behaviours could play an important role in blood pressure control during pregnancy and beyond. However, an understanding of how to best support women with existing hypertension with this aspect of their blood pressure management during pregnancy is unknown.

Methods:

The DAPHNY study was an intervention development mixed methods study. Three workstreams were conducted to design and develop an App-based lifestyle intervention.

Workstream 1: An online cross-sectional survey for women with experience of chronic hypertension during pregnancy. This survey provided a snapshot of current knowledge, behaviours and attitudes towards healthy behaviours in relation to pregnancy and hypertension diagnosis. This helped inform the iterative development of the intervention.

Workstream 2: Focus groups were carried out with healthcare professionals to explore their views on a lifestyle intervention, find out how it may coexist within existing care pathways and identify important considerations for implementation.

Workstream 3: We conducted early feasibility testing which involved think-aloud interviews with women and individual interviews with women who tested the App at home. Participants involved in think aloud interviews were shown prototypes of the intervention and provided valuable feedback. Modifications to the App were made throughout based on this feedback. Participants who used the App for a short period at home provided a deeper insight into the realities of using the lifestyle App and informed considerations for any future implementation strategies to increase engagement.

How this could benefit patients:

Pregnant women with chronic hypertension experience little lifestyle support, in relation to their blood pressure, during pregnancy. Co-developing an App ensured supportive content and usability that addressed key barriers and facilitators. Early feasibility testing indicated important modifications to the interventions that are needed to improve user engagement and thus, uptake in healthy behaviours. Incorporating these modifications may support future trials that explore optimal blood pressure management during pregnancy. Engaging in positive lifestyle changes may improve blood pressure control, which is crucial for the health of both the mother and baby.