A prospective cohort study, understanding blood pressure changes in the immediate twelve weeks postpartum for women who had a hypertensive disorder in pregnancy and how existing care pathways identify and monitor women at risk of cardiovascular disease.

Background Hypertensive disorders occur in approximately 10% of pregnancies.

Evidence suggests that women who have hypertension in pregnancy are much more likely to develop cardiovascular disease (CVD).

Women with a hypertensive disorder of pregnancy (HDP) are twice more at risk of heart disease and stroke, and four times more likely to develop hypertension after birth.

Two out of three women who had hypertension in pregnancy will die from CVD (Pre-eclampsia Foundation, 2020) Recent evidence shows that young women are developing signs of CVD immediately in the postpartum period after HDP, rather than several decades later as previously presumed (Cain et al, 2016).

Healthcare professionals (HCPs) are therefore presented with a unique opportunity to influence women around their future lifestyles to help combat against CVD.

Hypothesis Hypertension is evident in a high proportion of women who had new onset of hypertension in pregnancy and much earlier in the postpartum period than previously assumed.

Aim To observe the recovery of maternal blood pressure (BP) after a pregnancy with new onset hypertension after twenty weeks gestation and to explore how postpartum care might be improved.

Objectives To observe the time course of recovery of maternal BP To measure the prevalence of persistent hypertension To assess the accuracy and acceptance of Home Blood Pressure Monitoring (HBPM) versus Ambulatory Blood Pressure Monitoring (ABPM) in the postpartum period To explore HCPs' knowledge and awareness of postpartum CVD risks and appropriate prevention strategies Methods This will be a prospective cohort study design.

Participants with new onset of hypertension during pregnancy will be asked to complete three days of HBPM every fortnight for twelve weeks with a twenty-four hour ABPM assessment at twelve weeks postpartum.

Women will be asked to self report following their GP appointment at eight weeks postpartum, to assess whether their BP was measured and what lifestyle advice they were given to reduce the risk of CVD.

Midwives and GPs will be asked to complete a cross sectional questionnaire after twelve months of primary data collection assessing their knowledge and awareness of HDP.

Outcomes Key time points when BP should be monitored after birth Confirmation of the most suitable approach to BP monitoring? (ABPM or HBPM) Identification of women who would benefit from closer BP monitoring Gaps in knowledge about HDP and risk of CVD amongst HCPs Anticipated Impact and Dissemination This research aims to highlight gaps in the current provision of postnatal care for women who had HDP.

Data from this study will inform the improvement of care for women who had HDP to reduce the risks of CVD.

The results of this study will be distributed via peer reviewed academic journals, educational maternity update events for GPs and midwives and presenting at conferences and Action on Pre-eclampsia (APEC) expert meetings.

Disseminating the results is anticipated to engage key stakeholders to spread the message and increase awareness of the prevalence of postnatal hypertension after HDP and what role HCPs play in the monitoring of hypertension and prevention of CVD.