DAPHNY: Diet and Activity for Pregnancy Hypertension

Study Aims:

Pregnant women with chronic hypertension (long-term high blood pressure) may benefit the most from additional lifestyle support during the antenatal period. The aim of the DAPHNY study is to work with women who have experienced long-term high blood pressure during pregnancy and their healthcare professionals to design and develop a digital lifestyle intervention to improve health behaviours.

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 with chronic hypertension require additional support and close antenatal surveillance as they are at increased risk of poor outcomes.

In non-pregnant populations, there is an established body of evidence supporting the role of diet and physical activity in blood pressure control. Many studies conducted in the general pregnant population show that improvements in diet and increased physical activity levels can result in better weight management during pregnancy which is closely linked with blood pressure control. The effect on clinical outcomes, including blood pressure, remains unknown. Pregnant women with existing hypertension are often excluded from these studies despite the fact that they may benefit the most from lifestyle modification, as observed outside of pregnancy. Additionally, there are few digital lifestyle interventions that have been designed or tested with this important population.

Methods:

DAPHNY is an intervention development mixed methods study. The full protocol can be viewed here. Three workstreams will be conducted to design and develop the digital lifestyle intervention.

Workstream 1: An online cross-sectional survey for women with experience of chronic hypertension during pregnancy. This survey will capture current knowledge and experience of lifestyle change in and outside of pregnancy which will help our understanding of the barriers and facilitators for positive behaviour change. If you wish to complete the survey, you can access it by clicking here.

Workstream 2: We are conducting focus groups with healthcare professionals to explore their views on a lifestyle intervention and find out how it may add to existing care pathways and identify any barriers that need to be considered when developing the intervention.

Workstream 3: We are conducting early feasibility testing of the lifestyle intervention with women. This involves think-aloud interviews with women who will be shown example prototypes of the intervention. They will provide valuable feedback that will help develop the intervention. The intervention will be adapted as more feedback and understanding is gained. Following the think-aloud interviews, we will invite a group of women to use the draft version of the App for a short period. We will carry out interviews after this to gain a deeper understanding of the acceptability and usability of the intervention.

How this could benefit patients:

Developing a digital intervention alongside women with experience of chronic hypertension in pregnancy and their healthcare professionals will ensure that the content, design and usability is maximally acceptable, feasible and accessible. It is hoped that this will improve the overall effectiveness and implementation of the intervention.