Three days after the birth of her first child, Melissa Urban was recovering at Bridgeport Hospital when suddenly her blood pressure spiked. Hospital staff sent her back to the labor and delivery unit for a 24-hour magnesium treatment to get it under control. But after Urban took both magnesium and additional medication, her blood pressure was still high. It wasn’t responding to treatment the way her healthcare providers had hoped.
Over the next five days, amid visits from many members of the staff, Urban was introduced to Tabassum Firoz, MD, the internal and obstetric medicine practitioner who runs Bridgeport’s Postpartum Heart Care Program. She credits Dr. Firoz with helping to stabilize her blood pressure so that she could be discharged from the hospital. That was in 2021, and Urban is still a patient of Dr. Firoz’s today.
The Postpartum Heart Care Program at Bridgeport provides a type of follow-up care for pregnant people who experience cardiac complications—in particular, preeclampsia (sudden high blood pressure that develops during pregnancy)—that’s unusual to find in the United States. It is one of the Northeast’s first programs dedicated to reducing the likelihood of heart disease in women who have experienced complicated pregnancies.
Patient Care First
According to Dr. Firoz, some of these pregnancy-specific conditions put women at risk for medical issues in the future, which could lead them to develop cardiovascular disease as soon as 10 years after giving birth. “This was kind of an ignored area because in the maternal health space, often women’s reproductive lives are viewed very separately from the rest of their health,” she said.
The Postpartum Heart Care Program was launched in 2020, and much of its referral base comes from existing patients, which is how Urban got into it. It accepts people regardless of their insurance status, so high-risk populations (among them women of color who often experience complications, but don’t receive follow-up care) are able to get comprehensive treatment. Over 80% of participants are Black or Latinx; most have Medicaid or are uninsured. At least 40% have more than two cardiovascular risk factors.
The program designs its treatment plans to meet the needs of each individual patient. These include lifestyle changes, nutrition consultations, medication management, care team coordination, connections to other resources, and a transition to primary care.
Dr. Firoz told Health that Bridgeport’s program is unique because it operates under the hospital’s primary care clinic—which offers the support of all the services that includes—rather than functioning as a stand-alone program. While most postpartum heart health clinics in the United States are run by high-risk obstetricians, her training in obstetric internal medicine gives her a slightly broader scope of knowledge. An obstetrician specializes in delivering babies and providing prenatal and postnatal care, but an internist treats adults with all sorts of chronic conditions.
Treating the Whole Person
In general, the program takes a fairly holistic approach. It considers patients’ health history, pregnancy complications, and any socially determined barriers they face to being healthy. “I talk to them about nutrition and exercise and sleep and mental health, and the social determinants of health, like finances, housing, transportation, and safety at home,” said Dr. Firoz, “because we know that 90% of heart disease is preventable.”
For Urban, it took months after the birth of her son to get to the root of her high blood pressure. Dr. Firoz set her up with an endocrinologist, cardiologist, sleep specialist, and nutritionist, all of whom served as her care team as she managed her heart health going forward. At a time when most new moms are busy focusing on adjusting to life with a newborn and physically recovering from labor, having access to the clinic made it easier for Urban to get the follow-up care she needed.
“You know, I don’t think I ever would have sought out answers to these things and sought out specialists on my own,” she said. “This program kind of just got me in with all these doctors.”
Urban was eventually diagnosed with obstructive sleep apnea—a condition she said she never would have considered without Dr. Firoz’s encouragement to see a sleep specialist. When untreated, obstructive sleep apnea can become a risk factor for high blood pressure. Urban was prescribed a CPAP machine, which she says played a role, along with medication, in returning her blood pressure to a normal, healthy level.
Thanks to careful care and management from Bridgeport’s Postpartum Heart Care Program, Urban is four months along in her second pregnancy and her blood pressure remains under control. “I’m 16 weeks in, and there haven’t been any issues or changes, she noted. “The pregnancy itself is healthy so far. It’s going really well.”
