Health coaching after labor and delivery significantly improves blood pressure control for women with a hypertensive disorder during pregnancy (HDP), while doubling the likelihood of attending follow-up visits with a primary care clinician, according to a randomized clinical trial published in JAMA Network Open.

The disorders, including gestational hypertension and preeclampsia-eclampsia, are a leading cause of pregnancy-related death and are associated with the development of heart failure, cerebrovascular disease, chronic hypertension, and cardiovascular disease. Roughly 15% of pregnant women have an HDP. Yet many patients disengage from medical care after delivery.

Coaching did not focus specifically on reducing blood pressure but on the patient’s health goals, said Megan Knutson Sinaise, MS, exercise physiologist at the University of Wisconsin-Madison Prevention Research Center, who led the study.

“It’s scary, traumatic, and surprising to be diagnosed with a hypertensive disorder of pregnancy,” Sinaise said. “So a lot of these people really did care about their blood pressure, and I really had to let them lead the conversation and ask for permission to share evidence-based guidance, such as reducing or eliminating alcohol and avoiding trans fats.”

The American Heart Association has called for continuous cardiovascular care after pregnancy complications such as HDP, including risk assessment, lifestyle counseling, and better coordination between obstetric and primary care clinicians.

Primary care clinicians are often not aware their patient had one of the disorders due to not sharing the same electronic health record or a lack of handoff from obstetrics. Follow-up visits are critical for monitoring blood pressure, assessing long-term cardiovascular risk, and starting or adjusting medication.

Coaching for Connection

The study took place between 2023 and 2025 at a single community hospital in Madison, Wisconsin, and included 140 randomly assigned postpartum women (mean age, 33 years; 75% White) who had hypertension or an HDP diagnosis. All participants had previously completed a 6-week remote blood pressure monitoring program to learn how to take accurate measurements. More than half of the participants took antihypertensive medications at enrollment (63.8% in the control group and 57.1% in the intervention group).

Patients in the intervention group had 20-minute phone calls with health coaches who reviewed their blood pressure and weight measurements over the course of 14 visits for 10 months. They also worked on patient-directed health goals, such as incorporating more fruits and vegetables into their diets. Coaches acted as a liaison with patients’ doctors, alerting them to high blood pressure readings or adverse events that required follow-up.

The intervention group was associated with improved blood pressure outcomes. Women who received coaching had a 5.6 mm Hg greater reduction in systolic blood pressure and a 4.5 mm Hg greater reduction in diastolic blood pressure than those in the control group. Blood pressure < 130/80 mm Hg at 12 months was more likely among intervention group participants than among control group participants (risk ratio, 1.73; 95% CI, 1.13-2.66; P = .02).

Primary care visits were attended by 71% vs 39.1% of intervention group participants vs control group participants. Both groups reduced their medication use by the end of the trial (33.8% in the control group and 35.3% in the intervention group). Health coaching did not significantly improve physical activity or diet.

More frequent engagement with clinicians was associated with lower blood pressure.

“This trial addresses a critical gap in the postpartum care continuum by extending structured support beyond delivery through a relatively low-burden, scalable intervention,” wrote Kara Whitaker, PhD, MPH, associate professor in the Department of Health and Human Physiology at the University of Iowa in lowa City, in an accompanying commentary. “The remote delivery model enhances potential reach, particularly for populations facing geographic or logistical barriers to care.”

But the intervention may not be realistic for many primary care practices, said Lynn Yee, MD, MPH, associate professor of obstetrics and gynecology and chief of the Division of Maternal-Fetal Medicine at Northwestern University Feinberg School of Medicine in Chicago, who was not associated with the study.

“It would be amazing if our health system could support everybody having a health coach with that level of expertise — the postpartum period is a time of stress, competing demands, amplified social needs, and family challenges, so people often don’t prioritize their own health,” Yee said. But “it’s just not practical in the United States.”

The sources in this article reported no relevant disclosures.

Brittany Vargas is a journalist covering medicine.