For the Love of Health

Treating Pregnancy Like Heart Disease with Dr. Matt Hoffman

• ChristianaCare • Season 2 • Episode 14

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 15:54

Chronic hypertension, also known as high blood pressure, can be life-threatening for pregnant women. According to the National Institutes of Health, the prevalence of chronic hypertension in pregnancy in the United States doubled between 2007 and 2021.

Research being done at ChristianaCare could change the lives of women around the world. Leading that research is Dr. Matthew Hoffman, the Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics & Gynecology at ChristianaCare, who joins us to talk about the results of those studies, changes in how health providers approach pregnancy care, and what the future may hold for maternal and fetal medicine.

Dr. Matthew K. Hoffman, M.D., MPH is the Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology for ChristianaCare. He has spearheaded national improvements in OBGYN care and has helped guide the health system to provide greater quality and value.

Links

Thanks for listening and subscribing! Follow us on Facebook, Instagram, X and LinkedIn.

Speaker 2

Treating the mother as if she is a cardiac patient in fact improves outcomes everyone, I'm Megan McGerman. And I'm Jason Tokarski. Welcome to another episode of For the Love of Health brought to you by Christiana Care.

Speaker 3

Chronic hypertension, also known as high blood pressure, can be life-threatening for pregnant women. According to the National Institutes of Health, the prevalence of chronic hypertension in pregnancy in the US doubled between 2007 and 2021.

Speaker 2

Research being done at Christiana Care could change the lives of women around the world. To talk more about this research is Dr Matt Hoffman, the Marie E Pinizzato MD endowed chair of obstetrics and gynecology at Christiana Care. Matt, thanks so much for joining us here today. My pleasure, jason. You've co-authored studies that have appeared in the New England Journal of Medicine and the Lancet. Can you tell us some of what it is that you've discovered and you've been working on in terms of pregnancy and high blood pressure?

Speaker 1

So we worry quite a bit about preeclampsia, which is sort of a broader generic term for a number of blood pressure problems. We know that one in 10 mothers will get this and often leading to prematurity, stillbirth, other complications. So the two different studies are sort of different but overlap in that the commonality is treating the mother as if she is a cardiac patient in fact improves outcomes. So we have come to pivot to think that the placenta is a lot like the heart. So if you think about the placenta, it's the only organ that you have what's built to last for 40 weeks. In the New England Journal of Medicine we learned that you have what's built to last for 40 weeks. In the New England Journal of Medicine we learned that by more tightly titrating people's blood pressure, just like cardiac disease, we can prevent progression.

Speaker 1

The aspirin study is a little bit more fascinating. That was giving aspirin to 12,000 women, just simply first-time moms. We found not only did it prevent preeclampsia but also stillbirth and also prematurity. So one of the key findings of that is understanding that most of those conditions really have their origins in the placenta. And if we can build a placenta that's healthier, particularly early, that we can really change those outcomes. And again we're having a lot of other research that really is sort of aligning with what we would call cardiovascular risk factors or really pregnancy risk factors.

Speaker 3

So these studies were published in 2020 and 2022. We're now in 2025. How have these studies grown? What are you seeing now?

Speaker 1

So the aspirin study has taken a life of its own. It is shaping both national guidelines as well as international guidelines. The aspirin study has taken a life of its own. It is shaping both national guidelines as well as international guidelines. The aspirin study was actually done in 12 low-middle-income countries. So, for example, I was just on with the regulatory body of India and they are looking and changing their way that they approach it. It's also brought up other issues. So currently in the US we have a system wherein we try to score people to understand the risk. Again, the US guidelines are going back and re-looking at that more permissive approach of giving it to all first-time mothers is sort of now causing them to rethink.

Speaker 1

The other part is we followed up on that study. I mean looking at the kids. So again, anytime mom takes medication and intervention, we want to make sure that we're not just affecting the pregnancy but really that we're having a long-term benefit. So we followed up on those children, saw that they were comparable. If anything, there was a trend to better neurodevelopmental outcomes. And then a colleague of mine then looked at a larger data set where moms had taken aspirin actually in the 50s through the 70s and actually found that children had less neurodevelopmental challenges if the mother had taken aspirin. So again, not just thinking about the pregnancy but thinking about the child long-term. The other part is again going back to the idea of cardiovascular disease. We know that moms who have preeclampsia and preterm birth really have much higher risk of all the cardiovascular risk factors, much more likely have a stroke, a heart attack, renal failure. So we're now following up on those moms to understand. Can we predict those moms? How do we intervene in those moms Thinking about pregnancy as a window to their own cardiovascular future?

Speaker 3

You mentioned the 50s and the 70s. Pregnancy is clearly not a new concept. Why are we just now thinking about it like heart disease?

Speaker 1

Based upon sort of our history, we've long thought of this as a hormonal phenomenon and there's an old joke in maternal-fetal medicine we talk way too much about the mom and the baby. We're now really thinking about the placenta, the placental blood flow, and then the other part which is sort of a problem with preeclampsia is we very much have a model of following people, identifying them and rescuing. So the treatment for preeclampsia, stabilization and ultimately deliver. We're now learning that we can intervene, but it probably has to be in that 10 to 16 week window when the placenta actually starts to really invest in the lining of the uterus and that's where the whole blood flow begins to happen. So a lot like adolescence if you have good habits in an adolescent, it plays out through the rest of your life rather than simply just trying to decrease your risk factors. So the New England Journal of Medicine study was somewhat decreasing risk factors versus the aspirin study was really about setting up and building a healthy placenta.

Speaker 2

Clearly, we're focused on this study that had a lot of impact based on the aspirin going to pregnant mothers. But what else should a pregnant woman be doing? What else should they be monitoring or changing in their lifestyle that can help to improve their pregnancy?

Speaker 1

Yeah. So we're putting a lot of thought in this and again we're now thinking much more along the lines of cardiovascular disease. So we had done a study of 10,000 first-time moms and found that those mothers who ate a more Mediterranean plant-based olive oil actually fish. And again, there had been some thoughts that fish was dangerous because of mercury. We're now pivoting the opposite direction.

Speaker 1

We're much less likely to have the blood pressure problems, preterm birth problems, small baby problems and most of that coming from the placenta. So the other part that we have found and again this is a somewhat different study that we published in the Journal of American Medical Association we looked at women at high risk for preterm birth and the intervention was different. One of the things we did is we put a pedometer on them. We found that those moms who worked 3,500 steps a day much less likely to deliver early. So we're starting to think about how do we intervene in terms of lifestyle, not just simply medicalize through blood pressure control and aspirin. It probably is going to take all of those things together to really meaningfully continue to impact on outcomes.

Speaker 3

And Matt, how do we change just the general conversation around this? You know I've been pregnant twice. There are many pregnant women who think I'm going to eat all the Chick-fil-A and all the ice cream and hang out and none of it really matters as long as you know baby is okay. How do we change that conversation that says eat the fish and make sure you're getting those steps in?

Speaker 1

Behavioral change is one of the hardest things to do. One of the things we know is that folks, when they're pregnant, are vested. And again going back to the idea of here's an important time window and if we can have those conversations deeper One of the thought processes again how do we also monitor folks, how do we incentivize them? How do we think about this? We've had some conversations with some folks in what's called the Penn Nudge Unit and they looked at giving moms a pedometer after they delivered and again they were interested in long-term cardiovascular and they simply had them at a contest. What group of four women could beat the other four women? And actually those women walked more. So again, I think part of it is us as providers to say this is important. The other part is how do we get those supports to help people to change behaviors, to build those habits? Over a 21-day period we can get folks to, particularly early on, do those behaviors, that we can make a difference, particularly that 10 to 16-week interval which is so critical.

Maternal Health Innovations and Research

Speaker 2

All right. So we have a whole bunch of ideas here of what we need to do to help women get the best pregnancy experience that they can possibly have. What is your team here at Christiana Care doing to make sure those best possible outcomes actually happen?

Speaker 1

So we've tried to really kind of endorse the idea of radical convenience. We have built into a common visit, the 11 to 13 week ultrasound visit, where we're able to pick about half the anomalies up. Same time. We also screen for all the genetic disorders and draw their blood at the same time Do a blood pressure and if a mom has a high blood pressure we give her a blood pressure cuff and start monitoring throughout her pregnancy and then additionally we screen her for diabetes and if she has diabetes, begin that. We've actually been able to working with Lisa Blunt.

Speaker 1

Rochester received a congressional earmark where we're taking moms who are Medicaid, who are obese, actually giving their family 40 meals a week and again feeding the family, but also coupling with the support of community health workers, sort of having your aunt show up a couple times a week to cook a meal with you and giving them their choices of things that are healthy for them and following the outcomes. Babyscripts is another exciting project. We were able to get an FCC grant to support this. Part of what we recognized is today's generation, particularly first-time moms. 70% of those folks are going to download a pregnancy app. So can we create ongoing communication? Can we break down big messaging. If you think about prenatal care, we'll see people with perfect prenatal care about seven hours.

Speaker 1

Think about the duration of pregnancy. You're talking 40 weeks times, 24 hours a day. You know we don't have that time to fill. We're less than 1%. So how do we fill it in with digital text? How do we keep folks involved? We also send a number of other texts. We send about 30,000 texts a month we're now thinking about also how do we start to weave in those healthy behaviors and how do we continue to support them so that work is early going on and having discussions about is this the time we give folks a pedometer? How do we have that to not overwhelm people Knowing that's a lot to pack in, but we have a limited window of opportunity.

Speaker 2

Based on a lot of the recommendations that are being made here and knowing from my own family's personal experience, where there was a lot of the recommendations that are being made here, and and knowing from my own family's personal experience, where there was a lot of gestational diabetes. So eat this, don't eat this, but these are the things you should, but, and and on like that. And we're also throwing in the, the pedometer and and the aspirin. How do you present that to the mother without completely overwhelming her of of what she should and shouldn't be doing?

Speaker 3

I've been there.

Speaker 2

It's overwhelming regardless of what you just said yeah.

Speaker 1

Yeah, no, I mean, pregnancy really is one of those profound times. If you think about your life before you had a child and afterwards they look markedly different Again. Digital communication, continued engagement and then continuing to have everybody be on the same page of this. So you know, the food pharmacy program is great because it's not just me as a provider providing it to them, but now I've got a community health worker who's going to go into the home, spend time with that person, support that person in their family. For the aspirin we provide digital touches.

Speaker 1

So one of the things which was interesting when we started aspirin is providers would say buy aspirin. Parents wouldn't do it. We now hand them a bottle of aspirin and then we found that they would go home and they would talk to their family members and they would say you're not supposed to take aspirin. So now actually, when we prescribe it out of the EMR, they actually get a short video explaining all the benefits to make sure that everybody's getting the same education. And we learned we needed to educate not just them but their family. So my word counts somewhat. The patient's mother or mother-in-law probably has equal, if not greater, weight. So if we can get everybody on the same page, but it's a journey.

Speaker 3

And, matt, you're doing, as you mentioned, international studies on all of this. What is to come? What are you currently working on?

Speaker 1

You know, I think one of the things, megan, is to continue to develop and engage a research community at Christiana and again part of that is the engagement of the community. So we've been very fortunate in that we've had the support to do that and also a community that understands and agrees with the need to continue to improve things. There's a few things which we're still working on funding, one of which is actually to look at the back of people's eyes at 11 to 13 weeks. So it turns out what happens in the uterus is those blood vessels remodel. The one set of blood vessels that we can actually look at is the back of your eye. It turns out, at least in the first 1,000 patients it's highly predictive of preeclampsia. So we're looking to expand that to a population of about 1,000 to now 10,000. That uses AI and again, that's been an interesting journey.

Speaker 1

We're also looking at a second intervention and, again still in early funding, looking at two studies, one a treatment and one a prevention study. There's an amino acid called L-arginine Again, this may be getting a little wonky, apologize Turns out babies don't make it, but moms do. And it turns out when you break down L-arginine it releases something called nitric oxide that allows our blood vessels to open up lowers our blood pressure. We've known that preeclamptic moms have low nitric oxide, so can we give them L-arginine and then actually treat or prevent preeclampsia. So again, it's a very similar idea of treating early, early planning, early funding for both of those, but trying to think things a little bit differently.

Speaker 3

As Jason mentioned, pregnancy can just be an incredibly overwhelming experience. What do you want the ChristianaCare patients, and all of the patients who may be impacted by this research, to understand from those doing this work?

Speaker 1

This is really a message about moving from treatment to prevention. You know, we know we need to continue to get better, we need better outcomes, but we also need to think differently. So research is about thinking differently. And then, as we do the research, how do we implement it to the community? How do we reach out with that messaging? How do we support people in that journey? And even simply handing a person a bottle of aspirin takes away the fact that we know historically, when I write a prescription, there's about a 30% chance that person's never going to pick it up. So now that I've provided it, I've at least eliminated those barriers. How do we make it radically simple for people to get the care they need and deserve?

Speaker 2

Matt, thank you so much for being here today. So much great information and I'm sure, since the research is constantly ongoing, we'll have you back at some point in the future to talk about it more. Looking forward to it. Thank you both. We'll have information on Dr Hoffman's research and Christiana Care's Center for Women's and Children's Health in the show notes for this episode.

Speaker 3

And you can always connect with us on social media. Just search Christiana Care on your favorite platform.

Speaker 2

We'll be back in two weeks with another great conversation.

Speaker 3

Until then, thanks for joining us for the Love of. Health.

Head Shot

Megan McGuriman

Co-host