A new collaboratively created digital companion aims to fill gaps in postnatal care by enabling women to monitor and manage long-term cardiovascular risks following pregnancy complications.
Research: Co-creation of a mobile medical program to prevent maternal cardiovascular disease following pregnancy complications (MumCare). Image credit: Josep Suria/Shutterstock.com
recent Frontiers of global women’s health In this study, we developed a new “digital companion” to support prevention and tracking of maternal cardiovascular risks in women with pregnancy complications.
Postpartum cardiovascular risk: current gaps and digital solutions
Cardiovascular disease (CVD) is a major cause of premature mortality and morbidity in women, but sex-specific etiologies remain understudied and women are underrepresented in research. Pregnancy complications such as hypertensive syndrome of pregnancy (HDP) and gestational diabetes mellitus (GDM) are strong predictors of future CVD, and pregnancy itself acts as a natural cardiovascular stress test. Despite CVD accounting for 35% of global female deaths in 2019, systematic postnatal prevention is still limited in practice and incidence continues to rise.
Myocardial infarction (MI) and stroke are the leading fatal CVD events in women. Early prevention strategies, especially those targeting hypertension, are most effective when implemented promptly. Up to one-third of women develop hypertension within 10 years after HDP, especially as the mother ages. Despite international recognition of these risks, routine postpartum cardiovascular evaluation remains rare.
Obstetric guidelines have historically lacked clarity regarding early CVD prevention after HDP and GDM, often relying on expert consensus rather than evidence. Some heart disease guidelines currently recommend a tailored approach, including regular screening for hypertension and diabetes. Norwegian guidelines recommend assessing cardiovascular risk at 3 months and 1 year postpartum, but it is unclear whether this is followed in practice.
Effectively reducing risk requires intervention before middle age. The immediate postpartum period after HDP or GDM is a critical period for early detection and intervention and provides an optimal opportunity for women to participate in their cardiovascular health management. Especially since pregnancy can stimulate long-term lifestyle awareness.
Electronic health or e-health refers to the use of digital technology and electronic communication tools to support and enhance healthcare services, health information management, and health-related activities. Systematic postnatal prevention supported by eHealth increases maternal health literacy and improves long-term cardiovascular disease outcomes.
However, despite strong patient demand and international calls for tailored digital health strategies, there are significant gaps in targeted eHealth-based postnatal interventions for cardiovascular risk management after HDP and GDM. Home blood pressure monitoring shows promise, but comprehensive digital support is still lacking.
Development and evaluation of MumCare to improve maternal health
The cardiovascular postnatal follow-up program was created as a mobile app based on Norwegian and international guidelines. The MumCare application (app) was developed in collaboration with users, stakeholders and clinical experts. Improvements were made through 5 qualitative interviews and 10 user testing sessions. this research Rather than evaluating clinical outcomes, we primarily analyze the iterative co-creation process used to develop apps.
The MumCare project team in Oslo includes an IT specialist, an obstetrician, a midwife, a general practitioner, two sociologists and two cardiologists, all with experience related to eHealth and women’s health. Medical students with technical and medical expertise helped translate the idea into functional app functionality for young women.
User representatives from two national patient organizations contributed to the input, adoption, design, and testing of the MumCare app. Both associations provided important user perspective and participated in interviews and app testing. Additional users of HDP or GDM at Oslo University Hospital were also involved throughout the co-creation process.
The app’s digital infrastructure prioritizes security and privacy with encryption, anonymization, and two-factor authentication. User data is stored securely on the app and, with the user’s consent, for research purposes on dedicated servers at the University of Oslo in accordance with GDPR and Norwegian regulations.
The linear Stage-Gate model structured the co-creation process and divided it into phases where quality checkpoints were evaluated during project meetings. This approach balances internal development with external user feedback to ensure apps are evidence-based, technically robust, and user-centric.
Improving postpartum health through technology
The MumCare app improves maternal health by coaching postpartum women through tracking blood pressure, weight, physical activity, and test results, and providing personalized feedback for self-management, primarily during the first year postpartum. It also includes educational resources such as videos and guideline-based information to support patient understanding and engagement.
This app is designed to support the transition from specialist pregnancy care to long-term follow-up with a general practitioner. It is designed as a “digital companion” or health coach and is not intended to replace clinical diagnosis or function as a medical device.
The co-creation process took place through four phases, focusing on technical and procedural development. In Phase 1, the technical foundations of the app were established with input from professional organizations and user representatives. It also reminds users of their 1-year postpartum follow-up with their general practitioner, which is a critical time to assess risk factors and future care needs. Representatives from user organizations provided feedback and directly guided content and feature development during Phase 1.
Phase 2 interviews confirmed users’ desire to monitor cardiovascular risk factors following HDP and GDM. This analysis highlighted three themes: self-care strategies and uncertainties regarding hypertension, the need for accessible health information, and the need for a more personalized approach to blood pressure monitoring with apps. Concerns were raised that frequent monitoring and use of apps could increase stress and create a sense of burden.
In Phase 3, we revised the app’s design and functionality based on your feedback to improve usability and ensure it meets our users’ needs. These changes have resulted in a more intuitive and supportive interface for pregnant and post-pregnant women.
In Phase 4, we built a prototype based on the updated design and made further improvements after testing with the project team and users. Initial pilot testing with a small number of users suggests that the app accomplishes its goals and works as intended.
conclusion
The MumCare app was co-created with input from experts, user organizations and patients over four phases. While early expert and organizational contributions helped define the app’s goals, continued feedback from patients ensured that the design and content met users’ actual needs. This collaborative approach has resulted in an app tailored to support women with pregnancy complications.
The MumCare app is currently being evaluated in a randomized controlled clinical trial starting in June 2024, and results are needed to determine its effectiveness in improving long-term cardiovascular outcomes.
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