A new co-created digital companion aims to close the postpartum care gap by helping women monitor and manage long-term cardiovascular risk after pregnancy complications.
Study: Co-creation of a mobile health program (MumCare) for preventing maternal cardiovascular disease after pregnancy complications. Image credit: Josep Suria/Shutterstock.com
A recent Frontiers in Global Women’s Health study developed a novel “digital companion” to help support the prevention and follow-up of maternal cardiovascular risk for women with pregnancy complications.
Postpartum cardiovascular risk: current gaps and digital solutions
Cardiovascular disease (CVD) is the leading cause of premature death and morbidity in women, yet sex-specific etiologies remain understudied, and women are underrepresented in research. Pregnancy complications, including hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), are strong predictors of future CVD, with pregnancy itself acting as a natural cardiovascular stress test. Despite CVD accounting for 35 % of global female deaths in 2019, systematic postpartum prevention is still limited in practice, and incidence continues to rise.
Myocardial infarction (MI) and stroke are the main fatal CVD events in women. Early preventive strategies, particularly those targeting hypertension, are most effective when implemented promptly. Up to one-third of women develop hypertension within a decade after HDP, especially with increasing maternal age. Despite international recognition of these risks, routine postpartum cardiovascular assessment remains rare.
Obstetric guidelines have historically lacked clarity on early CVD prevention after HDP and GDM, often relying on expert consensus rather than evidence. Some cardiology guidelines now recommend personalized approaches, such as periodic hypertension and diabetes screening. Norwegian guidelines recommend cardiovascular risk evaluation at 3 months and 1 year postpartum, but adherence in practice is uncertain.
Effective risk reduction requires intervention before middle age. The immediate postpartum period following HDP or GDM is a critical window for early detection and intervention, offering an optimal opportunity to engage women in cardiovascular health management, particularly as pregnancy can motivate long-term lifestyle awareness.
Electronic health or e-health refers to the use of digital technologies and electronic communication tools to support and enhance healthcare services, medical information management, and health-related activities. Systematic, eHealth-supported postpartum prevention can enhance maternal health literacy and improve long-term cardiovascular outcomes.
However, there is a significant gap in targeted, eHealth-based postpartum interventions for cardiovascular risk management after HDP and GDM, despite strong patient demand and international calls for coordinated digital health strategies. Home blood pressure monitoring offers promise, but comprehensive digital support remains insufficient.
Developing and assessing MumCare for maternal health improvement
A cardiovascular postpartum follow-up program was created as a mobile app, based on Norwegian and international guidelines. The MumCare application (app) development involved users, stakeholders, and clinical experts through co-creation. Five qualitative interviews and 10 user testing sessions informed improvements. This study primarily analyzes the iterative co-creation process used to develop the app, rather than evaluating clinical outcomes.
The MumCare project team in Oslo included an IT expert, obstetricians, a midwife, a GP, two sociologists, and two cardiologists, all with relevant experience in eHealth and women’s health. A medical student with technological and medical expertise contributed to translating ideas into functional app features for young women.
User representatives from two national patient associations contributed to information, recruitment, design, and testing of the MumCare app. Both associations offered key user perspectives and participated in interviews and app testing. Additional users with HDP or GDM at Oslo University Hospital were also involved throughout the co-creation process.
The app’s digital infrastructure prioritizes security and privacy, with encryption, de-identification, and two-factor authentication. User data is stored securely on the app and, for research purposes and with user consent, on a dedicated University of Oslo server, complying with GDPR and Norwegian regulations.
A linear Stage-Gate model structured the co-creation process, dividing it into phases with quality checkpoints evaluated in project meetings. This approach balanced internal development and external user feedback, ensuring the app is evidence-based, technically robust, and user-centered.
Enhancing postpartum well-being through technology
The MumCare app improves maternal health by guiding postpartum women through tracking blood pressure, weight, physical activity, and lab results, and by providing personalized feedback for self-management, primarily during the first postpartum year. It also includes educational resources such as videos and guideline-based information to support patient understanding and engagement.
The app is also designed to support the transition from specialist pregnancy care to long-term follow-up with general practitioners. It is designed as a “digital companion” or health coach and does not replace clinical diagnosis or function as a medical device.
The co-creation process followed four phases focused on technical and procedural developments. In Phase 1, input from expert organizations and user representatives established the app’s technical foundation. It also reminds users of the one-year postpartum follow-up with their general practitioner, a key time to assess risk factors and future care needs. User organization representatives gave feedback in Phase 1, directly guiding content and feature development.
Phase 2 interviews confirmed users want to monitor cardiovascular risk factors after HDP and GDM. The analysis highlighted three themes: self-care strategies and uncertainties about hypertension, the need for accessible health information, and a call for a more personalized approach to blood pressure monitoring in the app. Concerns that frequent monitoring or app use could increase stress or create a sense of burden were noted.
In Phase 3, the app’s design and features were revised based on feedback to improve usability and ensure they met users’ needs. These changes led to a more intuitive and supportive interface for women during and after pregnancy.
Phase 4 involved building a prototype based on the updated designs, with further refinements made after testing by the project team and users. Initial pilot testing with a small number of users suggested the app met its objectives and functioned as intended.
Conclusion
The MumCare app was co-created with input from experts, user organizations, and patients over four phases. Early expert and organizational contributions helped define the app’s goals, while ongoing feedback from patients ensured the design and content met users’ real needs. This collaborative approach resulted in an app tailored to support women with pregnancy complications.
The MumCare app is currently being evaluated in a randomized controlled clinical trial that began in June 2024, with results needed to determine its effectiveness in improving long-term cardiovascular outcomes.
Download your PDF copy by clicking here.
Space research accelerates heart disease studies and tissue engineering