xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06019715</url>
    </required_header>
    <id_info>
      <org_study_id>202302470</org_study_id>
      <nct_id>NCT06019715</nct_id>
    </id_info>
    <brief_title>Remote Postpartum Intervention Targeting Movement Behaviors After Hypertensive Disorders of Pregnancy</brief_title>
    <official_title>Remote Postpartum Intervention Targeting Movement Behaviors After Hypertensive Disorders of Pregnancy</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Jackie Dziewior</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>University of Iowa</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        The purpose of this study is to test the feasibility, acceptability, and preliminary efficacy&#xD;
        of a postpartum physical activity intervention after a pregnancy complicated by a&#xD;
        Hypertensive Disorder of Pregnancy. The study will also assess the effects of the remote&#xD;
        postpartum intervention on blood pressure. To do this, we will recruit individuals that are&#xD;
        3-6 months postpartum a pregnancy complicated by a hypertensive disorder to participate in a&#xD;
        4-month health coaching intervention aimed to promote physical activity and was informed by&#xD;
        formative work done previously.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        I.a Clinical and Public Health Significance. CVD is the leading cause of death among women in&#xD;
        America; one in four of these deaths are preventable.3 HDP, including gestational and chronic&#xD;
        hypertension, preeclampsia, and superimposed preeclampsia, are risk factors for CVD.3 HDP are&#xD;
        associated with maternal and offspring morbidity and mortality, negatively impacting&#xD;
        cardiovascular, immune, and neurological systems.21 With 10% of all pregnancies affected by&#xD;
        HDP, targeting this population is critical to improving maternal/neonatal morbidity and&#xD;
        mortality and overall cardiovascular health in America.1,2 The proposed study answers the&#xD;
        AHA's call in their 2022 scientific statement for studies demonstrating efficacy of lifestyle&#xD;
        interventions addressing hypertension during the postpartum period among those with HDP.22&#xD;
  &#xD;
        I.b Cardiovascular changes during pregnancy act as a natural stress test and may uncover an&#xD;
        individual's potential risk of future CVD.23 Specifically, individuals with HDP are at an&#xD;
        immediately increased risk for HTN after delivery.1 Long-term cardiometabolic health is also&#xD;
        implicated by HDP, with increased risk of future CVD, morbidity, and mortality compared to&#xD;
        normotensive pregnancies.24 Odds of developing HTN at one year postpartum is 12 to 25 times&#xD;
        greater in HDP pregnancies compared to normotensive pregnancies.25 The 5-year likelihood of&#xD;
        developing HTN for pregnancies complicated by HDP is 7.1 times greater than normotensive&#xD;
        pregnancies.1 Even in those not diagnosed with HTN, the BP is on average greater in HDP women&#xD;
        than in normotensive pregnancies.26&#xD;
  &#xD;
        I.c Follow-up care for HDP in the postpartum period is inadequate. Although it is understood&#xD;
        that HDP place an individual at increased risk for future CVD, only 58% of women with HDP had&#xD;
        a 7-10 day postpartum BP check and 48% for a 6-month postpartum visit.4,25 In addition, only&#xD;
        17% of women with HDP follow-up with their primary care providers, indicating a gap in the&#xD;
        transition of care after pregnancy.25 Lack of follow-up has been attributed to fatigue, pain,&#xD;
        infant care obligations, time, and low awareness of HDP as a risk factor for future CVD.27,28&#xD;
        Although a few interventions have targeted future CVD risk in this population, few to no&#xD;
        studies account for these unique barriers experienced during the postpartum period.14,29&#xD;
  &#xD;
        I.d PA and SED have independent effects on CVD risk.8-10 PA and SED are modifiable risk&#xD;
        factors for CVD and have the potential to improve BP.30 Current studies suggest that moderate&#xD;
        to vigorous PA decreases after pregnancy, and evidence concerning SED is conflicting.31,32&#xD;
        PA, specifically aerobic exercise, has beneficial effects on mean, systolic, and diastolic BP&#xD;
        in adults.33,34 This association has been observed in pregnant populations as well, with the&#xD;
        greatest improvements seen in inactive individuals.35,36 SED is another modifiable risk&#xD;
        factor associated with CVD, independent of PA, with each additional hour of SED increasing&#xD;
        the risk for HTN.8 Although the effect on PA and SED in the general population are well&#xD;
        understood, the direct effects of PA/SED in the postpartum period on BP after HDP is&#xD;
        understudied.37&#xD;
  &#xD;
        I.e The perinatal period presents a critical period of change and a promising target for&#xD;
        lifestyle intervention to reduce future CVD risk. The association of HDP with future CVD&#xD;
        elicited AHA's call to action for more vigorous primary prevention of CVD in the postpartum&#xD;
        period.38,39 With increased contact to health care professionals during gestation, pregnancy&#xD;
        also offers an opportunity to connect with this population to develop positive health&#xD;
        behaviors, which our preliminary data confirms is feasible. Interventions promoting PA and&#xD;
        decreased SED in the postpartum period after a HDP is an under explored primary prevention&#xD;
        strategy.37&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Active, not recruiting</overall_status>
    <start_date type="Actual">June 1, 2023</start_date>
    <completion_date type="Anticipated">July 1, 2024</completion_date>
    <primary_completion_date type="Anticipated">March 1, 2024</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>N/A</allocation>
      <intervention_model>Single Group Assignment</intervention_model>
      <primary_purpose>Prevention</primary_purpose>
      <masking>None (Open Label)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>Change in physical activity</measure>
      <time_frame>6 months</time_frame>
      <description>Change in step count from baseline across study timeline</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Intervention feasibility</measure>
      <time_frame>6 months</time_frame>
      <description>Will be evaluated using Bowen's standards, specifically implementation and practicality. Implementation and practicability will be measured by the number of completed sessions out of the total session possible and by the quality of implementation through participant self-reported satisfaction of the program's session length, frequency, and topics covered.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>Intervention acceptability</measure>
      <time_frame>6 months</time_frame>
      <description>Will be evaluated using Bowen's standards, specifically acceptability and demand of the intervention. Acceptability and demand will be assessed by participant self-reported satisfaction and likelihood to recommend the program to other of participants. Acceptability, demand, and practicality will be defined by at least 75% of participants responding either satisfied or very satisfied to these questions; implementation by 75% of sessions attended.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Change in postpartum blood pressure</measure>
      <time_frame>6 months</time_frame>
      <description>Change in postpartum blood pressure from baseline across study timeline</description>
    </secondary_outcome>
    <number_of_arms>1</number_of_arms>
    <enrollment type="Actual">20</enrollment>
    <condition>Hypertensive Disorder of Pregnancy</condition>
    <arm_group>
      <arm_group_label>Intervention Arm</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>This arm will receive the full intervention, including 4 months of health coaching support, 8 virtual health coaching visits, a Fitbit device, and an at home blood pressure monitor.</description>
    </arm_group>
    <intervention>
      <intervention_type>Behavioral</intervention_type>
      <intervention_name>Postpartum Remote Physical Activity Intervention</intervention_name>
      <description>Includes 8 remote health coaching session to promote physical activity, use of a Fitbit device, and use of a home based blood pressure monitor.</description>
      <arm_group_label>Intervention Arm</arm_group_label>
      <other_name>The HyPE Intervention</other_name>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  &lt;6 months postpartum from a pregnancy complicated by a hypertensive disorder&#xD;
  &#xD;
            -  Have self-reported insufficient activity (&lt;150 minutes of moderate to vigorous&#xD;
               physical activity per week)&#xD;
  &#xD;
            -  Own a smartphone&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Current enrollment in another physical activity or sedentary behavior intervention&#xD;
               study&#xD;
  &#xD;
            -  Recommend to limit physical activity by a healthcare provider&#xD;
  &#xD;
            -  Diagnosed with diabetes, kidney disease, cardiovascular disease&#xD;
  &#xD;
            -  Prior bariatric surgery&#xD;
  &#xD;
            -  Currently takes medication to reduce weight or anti-hypertensives&#xD;
        </textblock>
      </criteria>
      <gender>Female</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>45 Years</maximum_age>
      <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
    </eligibility>
    <location>
      <facility>
        <name>University of Iowa</name>
        <address>
          <city>Iowa City</city>
          <state>Iowa</state>
          <zip>52242</zip>
          <country>United States</country>
        </address>
      </facility>
    </location>
    <location_countries>
      <country>United States</country>
    </location_countries>
    <reference>
      <citation>Melchiorre K, Thilaganathan B, Giorgione V, Ridder A, Memmo A, Khalil A. Hypertensive Disorders of Pregnancy and Future Cardiovascular Health. Front Cardiovasc Med. 2020 Apr 15;7:59. doi: 10.3389/fcvm.2020.00059. eCollection 2020.</citation>
      <PMID>32351977</PMID>
    </reference>
    <reference>
      <citation>Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013 Dec;15(6):659-68. doi: 10.1007/s11906-013-0386-8.</citation>
      <PMID>24052212</PMID>
    </reference>
    <reference>
      <citation>Evenson KR, Aytur SA, Borodulin K. Physical activity beliefs, barriers, and enablers among postpartum women. J Womens Health (Larchmt). 2009 Dec;18(12):1925-34. doi: 10.1089/jwh.2008.1309.</citation>
      <PMID>20044854</PMID>
    </reference>
    <reference>
      <citation>Lane-Cordova AD, Jerome GJ, Paluch AE, Bustamante EE, LaMonte MJ, Pate RR, Weaver RG, Webber-Ritchey KJ, Gibbs BB; Committee on Physical Activity of the American Heart Association Council on Lifestyle and Cardiometabolic Health. Supporting Physical Activity in Patients and Populations During Life Events and Transitions: A Scientific Statement From the American Heart Association. Circulation. 2022 Jan 25;145(4):e117-e128. doi: 10.1161/CIR.0000000000001035. Epub 2021 Dec 1.</citation>
      <PMID>34847691</PMID>
    </reference>
    <reference>
      <citation>Lui NA, Jeyaram G, Henry A. Postpartum Interventions to Reduce Long-Term Cardiovascular Disease Risk in Women After Hypertensive Disorders of Pregnancy: A Systematic Review. Front Cardiovasc Med. 2019 Nov 15;6:160. doi: 10.3389/fcvm.2019.00160. eCollection 2019.</citation>
      <PMID>31803757</PMID>
    </reference>
    <reference>
      <citation>Whitaker KM, Jones MA, Dziewior J, Anderson M, Anderson C, Gibbs BB, Carr LJ. Feasibility, acceptability, and preliminary efficacy of a single-arm, remotely-delivered health coaching intervention to increase physical activity and reduce sedentary behavior during pregnancy. BMC Pregnancy Childbirth. 2022 Oct 2;22(1):740. doi: 10.1186/s12884-022-05073-4.</citation>
      <PMID>36184599</PMID>
    </reference>
    <reference>
      <citation>Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002 Apr 2;136(7):493-503. doi: 10.7326/0003-4819-136-7-200204020-00006.</citation>
      <PMID>11926784</PMID>
    </reference>
    <reference>
      <citation>Hutchesson M, Campbell L, Leonard A, Vincze L, Shrewsbury V, Collins C, Taylor R. Do modifiable risk factors for cardiovascular disease post-pregnancy influence the association between hypertensive disorders of pregnancy and cardiovascular health outcomes? A systematic review of observational studies. Pregnancy Hypertens. 2022 Mar;27:138-147. doi: 10.1016/j.preghy.2021.12.017. Epub 2022 Jan 6.</citation>
      <PMID>35066405</PMID>
    </reference>
    <reference>
      <citation>Mehta LS, Sharma G, Creanga AA, Hameed AB, Hollier LM, Johnson JC, Leffert L, McCullough LD, Mujahid MS, Watson K, White CJ; American Heart Association Advocacy Coordinating Committee. Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association. Circulation. 2021 Oct 12;144(15):e251-e269. doi: 10.1161/CIR.0000000000001000. Epub 2021 Sep 8.</citation>
      <PMID>34493059</PMID>
    </reference>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>August 24, 2023</study_first_submitted>
    <study_first_submitted_qc>August 30, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 31, 2023</study_first_posted>
    <last_update_submitted>August 30, 2023</last_update_submitted>
    <last_update_submitted_qc>August 30, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 31, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor-Investigator</responsible_party_type>
      <investigator_affiliation>University of Iowa</investigator_affiliation>
      <investigator_full_name>Jackie Dziewior</investigator_full_name>
      <investigator_title>PhD Candidate</investigator_title>
    </responsible_party>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Toxemia</mesh_term>
      <mesh_term>Pregnancy Complications</mesh_term>
      <mesh_term>Pre-Eclampsia</mesh_term>
      <mesh_term>Hypertension</mesh_term>
    </condition_browse>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06019715
  org study id: 202302470
  nct id: NCT06019715
  lead sponsor: 
  has dmc: No
  is fda regulated drug: No
  is fda regulated device: No
  The purpose of this study is to test the feasibility, acceptability, and preliminary efficacy
        of a postpartum physical activity intervention after a pregnancy complicated by a
        Hypertensive Disorder of Pregnancy. The study will also assess the effects of the remote
        postpartum intervention on blood pressure. To do this, we will recruit individuals that are
        3-6 months postpartum a pregnancy complicated by a hypertensive disorder to participate in a
        4-month health coaching intervention aimed to promote physical activity and was informed by
        formative work done previously.
  I.a Clinical and Public Health Significance. CVD is the leading cause of death among women in
        America; one in four of these deaths are preventable.3 HDP, including gestational and chronic
        hypertension, preeclampsia, and superimposed preeclampsia, are risk factors for CVD.3 HDP are
        associated with maternal and offspring morbidity and mortality, negatively impacting
        cardiovascular, immune, and neurological systems.21 With 10% of all pregnancies affected by
        HDP, targeting this population is critical to improving maternal/neonatal morbidity and
        mortality and overall cardiovascular health in America.1,2 The proposed study answers the
        AHA's call in their 2022 scientific statement for studies demonstrating efficacy of lifestyle
        interventions addressing hypertension during the postpartum period among those with HDP.22
  
        I.b Cardiovascular changes during pregnancy act as a natural stress test and may uncover an
        individual's potential risk of future CVD.23 Specifically, individuals with HDP are at an
        immediately increased risk for HTN after delivery.1 Long-term cardiometabolic health is also
        implicated by HDP, with increased risk of future CVD, morbidity, and mortality compared to
        normotensive pregnancies.24 Odds of developing HTN at one year postpartum is 12 to 25 times
        greater in HDP pregnancies compared to normotensive pregnancies.25 The 5-year likelihood of
        developing HTN for pregnancies complicated by HDP is 7.1 times greater than normotensive
        pregnancies.1 Even in those not diagnosed with HTN, the BP is on average greater in HDP women
        than in normotensive pregnancies.26
  
        I.c Follow-up care for HDP in the postpartum period is inadequate. Although it is understood
        that HDP place an individual at increased risk for future CVD, only 58% of women with HDP had
        a 7-10 day postpartum BP check and 48% for a 6-month postpartum visit.4,25 In addition, only
        17% of women with HDP follow-up with their primary care providers, indicating a gap in the
        transition of care after pregnancy.25 Lack of follow-up has been attributed to fatigue, pain,
        infant care obligations, time, and low awareness of HDP as a risk factor for future CVD.27,28
        Although a few interventions have targeted future CVD risk in this population, few to no
        studies account for these unique barriers experienced during the postpartum period.14,29
  
        I.d PA and SED have independent effects on CVD risk.8-10 PA and SED are modifiable risk
        factors for CVD and have the potential to improve BP.30 Current studies suggest that moderate
        to vigorous PA decreases after pregnancy, and evidence concerning SED is conflicting.31,32
        PA, specifically aerobic exercise, has beneficial effects on mean, systolic, and diastolic BP
        in adults.33,34 This association has been observed in pregnant populations as well, with the
        greatest improvements seen in inactive individuals.35,36 SED is another modifiable risk
        factor associated with CVD, independent of PA, with each additional hour of SED increasing
        the risk for HTN.8 Although the effect on PA and SED in the general population are well
        understood, the direct effects of PA/SED in the postpartum period on BP after HDP is
        understudied.37
  
        I.e The perinatal period presents a critical period of change and a promising target for
        lifestyle intervention to reduce future CVD risk. The association of HDP with future CVD
        elicited AHA's call to action for more vigorous primary prevention of CVD in the postpartum
        period.38,39 With increased contact to health care professionals during gestation, pregnancy
        also offers an opportunity to connect with this population to develop positive health
        behaviors, which our preliminary data confirms is feasible. Interventions promoting PA and
        decreased SED in the postpartum period after a HDP is an under explored primary prevention
        strategy.37
  allocation: N/A
  intervention model: Single Group Assignment
  primary purpose: Prevention
  masking: None (Open Label)
  measure: Change in physical activity
  time frame: 6 months
  description: Change in step count from baseline across study timeline
  measure: Intervention feasibility
  time frame: 6 months
  description: Will be evaluated using Bowen's standards, specifically implementation and practicality. Implementation and practicability will be measured by the number of completed sessions out of the total session possible and by the quality of implementation through participant self-reported satisfaction of the program's session length, frequency, and topics covered.
  measure: Intervention acceptability
  time frame: 6 months
  description: Will be evaluated using Bowen's standards, specifically acceptability and demand of the intervention. Acceptability and demand will be assessed by participant self-reported satisfaction and likelihood to recommend the program to other of participants. Acceptability, demand, and practicality will be defined by at least 75% of participants responding either satisfied or very satisfied to these questions; implementation by 75% of sessions attended.
  measure: Change in postpartum blood pressure
  time frame: 6 months
  description: Change in postpartum blood pressure from baseline across study timeline
  arm group label: Intervention Arm
  arm group type: Experimental
  description: This arm will receive the full intervention, including 4 months of health coaching support, 8 virtual health coaching visits, a Fitbit device, and an at home blood pressure monitor.
  intervention type: Behavioral
  intervention name: Postpartum Remote Physical Activity Intervention
  description: Includes 8 remote health coaching session to promote physical activity, use of a Fitbit device, and use of a home based blood pressure monitor.
  arm group label: Intervention Arm
  other name: The HyPE Intervention
  criteria: 
  gender: Female
  minimum age: 18 Years
  maximum age: 45 Years
  healthy volunteers: Accepts Healthy Volunteers
  facility: 
  country: United States
  citation: Melchiorre K, Thilaganathan B, Giorgione V, Ridder A, Memmo A, Khalil A. Hypertensive Disorders of Pregnancy and Future Cardiovascular Health. Front Cardiovasc Med. 2020 Apr 15;7:59. doi: 10.3389/fcvm.2020.00059. eCollection 2020.
  PMID: 32351977
  citation: Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013 Dec;15(6):659-68. doi: 10.1007/s11906-013-0386-8.
  PMID: 24052212
  citation: Evenson KR, Aytur SA, Borodulin K. Physical activity beliefs, barriers, and enablers among postpartum women. J Womens Health (Larchmt). 2009 Dec;18(12):1925-34. doi: 10.1089/jwh.2008.1309.
  PMID: 20044854
  citation: Lane-Cordova AD, Jerome GJ, Paluch AE, Bustamante EE, LaMonte MJ, Pate RR, Weaver RG, Webber-Ritchey KJ, Gibbs BB; Committee on Physical Activity of the American Heart Association Council on Lifestyle and Cardiometabolic Health. Supporting Physical Activity in Patients and Populations During Life Events and Transitions: A Scientific Statement From the American Heart Association. Circulation. 2022 Jan 25;145(4):e117-e128. doi: 10.1161/CIR.0000000000001035. Epub 2021 Dec 1.
  PMID: 34847691
  citation: Lui NA, Jeyaram G, Henry A. Postpartum Interventions to Reduce Long-Term Cardiovascular Disease Risk in Women After Hypertensive Disorders of Pregnancy: A Systematic Review. Front Cardiovasc Med. 2019 Nov 15;6:160. doi: 10.3389/fcvm.2019.00160. eCollection 2019.
  PMID: 31803757
  citation: Whitaker KM, Jones MA, Dziewior J, Anderson M, Anderson C, Gibbs BB, Carr LJ. Feasibility, acceptability, and preliminary efficacy of a single-arm, remotely-delivered health coaching intervention to increase physical activity and reduce sedentary behavior during pregnancy. BMC Pregnancy Childbirth. 2022 Oct 2;22(1):740. doi: 10.1186/s12884-022-05073-4.
  PMID: 36184599
  citation: Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002 Apr 2;136(7):493-503. doi: 10.7326/0003-4819-136-7-200204020-00006.
  PMID: 11926784
  citation: Hutchesson M, Campbell L, Leonard A, Vincze L, Shrewsbury V, Collins C, Taylor R. Do modifiable risk factors for cardiovascular disease post-pregnancy influence the association between hypertensive disorders of pregnancy and cardiovascular health outcomes? A systematic review of observational studies. Pregnancy Hypertens. 2022 Mar;27:138-147. doi: 10.1016/j.preghy.2021.12.017. Epub 2022 Jan 6.
  PMID: 35066405
  citation: Mehta LS, Sharma G, Creanga AA, Hameed AB, Hollier LM, Johnson JC, Leffert L, McCullough LD, Mujahid MS, Watson K, White CJ; American Heart Association Advocacy Coordinating Committee. Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association. Circulation. 2021 Oct 12;144(15):e251-e269. doi: 10.1161/CIR.0000000000001000. Epub 2021 Sep 8.
  PMID: 34493059
  responsible party type: Sponsor-Investigator
  investigator affiliation: University of Iowa
  investigator full name: Jackie Dziewior
  investigator title: PhD Candidate
  mesh term: Toxemia
  mesh term: Pregnancy Complications
  mesh term: Pre-Eclampsia
  mesh term: Hypertension
  sharing ipd: No