Colorado Nurse Family Heart Trial for the ENRICH program

PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death in the United States, with disparately greater impact on racial/ethnic minorities and lower-income individuals. Risk for CVD begins very early in life as adverse exposures during critical periods (fetal development, infancy, and reproductive years) shift the health trajectory toward overt disease. Thus, efforts to promote and maintain cardiovascular health (CVH) from pregnancy onward are crucial to reducing the intergenerational burden of CVD. In response to the Early Intervention to Promote Cardiovascular Health of Mothers and Children request for applications (ENRICH RFA), we propose to leverage two widely-available interventions to promote CVH in diverse, under-resourced pregnant women and offspring: Nurse Family Partnership (NFP) and the National Diabetes Prevention Program (NDPP). NFP is a home visiting program in which nurses support first-time, under-resourced mothers from pregnancy to 24 months postpartum to improve prenatal outcomes, child safety and developmental outcomes, and economic self-sufficiency. NFP is available at >260 organizations nationwide, including our Denver Health partners who have delivered it to >2400 urban, under-resourced women since 2000. While NFP addresses some putative causes of compromised maternal and child health, CVH has not been comprehensively addressed nor evaluated. Thus, we propose to enhance NFP with CVH-focused programming adapted from the NDPP, a yearlong, evidence-based lifestyle intervention that promotes healthy eating and activity to reduce weight, dysglycemia, and other CVD risks, which we have delivered to >1600 diverse, under-resourced adults at Denver Health since 2013, including >340 young women. By leveraging unique strengths of NFP (home delivery model, professional nursing support, impact on social determinants of health [SDOH]) with those of NDPP (evidence-based content for CVH promotion), a combined intervention (NFP-Heart) rigorously evaluated in the ENRICH program has great potential to improve CVH outcomes in under-resourced populations. Our Colorado Nurse Family Heart Trial will evaluate NFP-Heart versus usual care among 600 nulliparous women (and their offspring) recruited in early pregnancy from 10 clinics in a safety-net, urban healthcare system. NFP-Heart will promote intergenerational CVH with programming delivered from 20 weeks gestation to 24 months postpartum by home visiting nurses. Our specific aims are 1) develop the local NFP-Heart and common ENRICH protocols, and conduct pilot studies to confirm feasibility and acceptability; 2) evaluate the effect of NFP-Heart on maternal and offspring CVH metrics; 3) assess the degree to which SDOH modify the effect of the NFP-Heart intervention on maternal and offspring CVH outcomes; and 4) examine the implementation of the NFP-Heart intervention and potential for sustainability using a mixed- methods approach.