Women's views and postpartum follow-up in the CHIPS Trial (Control of Hypertension in Pregnancy Study).
OBJECTIVE
To compare women's views about blood pressure (BP) control in CHIPS (Control of Hypertension In Pregnancy Study) (NCT01192412).


METHODS
Quantitative and qualitative analysis of questionnaire responses.


METHODS
International randomised trial (94 sites, 15 countries).


METHODS
911 (92.9%) women randomised to 'tight' (target diastolic blood pressure, 85mmHg) or 'less tight' (target diastolic blood pressure, 100mmHg) who completed questionnaires.


METHODS
A questionnaire was administered at ∼6-12 weeks postpartum regarding post-discharge morbidity and views about trial participation. Questionnaires were administered by the site co-ordinator, and contact was made by phone, home or clinic visit; rarely, data was collected from medical records. Quantitative analyses were Chi-square or Fisher's exact test for categorical variables, mixed effects multinomial logistic regression to adjust for confounders, and p<0.001 for statistical significance. NVivo software was used for thematic analysis of women's views.


METHODS
Satisfaction, measured as willingness to have the same treatment in another pregnancy or recommend that treatment to a friend.


RESULTS
Among the 533 women in 'tight' (N=265) vs. 'less tight' (N=268) control who provided comments for qualitative analysis, women in 'tight' (vs. 'less tight') control made fewer positive comments about the amount of medication taken (5 vs. 28 women, respectively) and intensity of BP monitoring (7 vs. 17, respectively). However, this did not translate into less willingness to either have the same treatment in another pregnancy (434, 95.8% vs. 423, 92.4%, respectively; p=0.14) or recommend that treatment to a friend (435, 96.0% and 428, 93.4%, respectively; p=0.17). Importantly, although satisfaction remained high among women with an adverse outcome, those in 'tight' control who suffered an adverse outcome (vs. those who did not) were not consistently less satisfied, whereas this was not the case among women in 'less tight' control among whom satisfaction was consistently lower for the CHIPS primary outcome (p<0.001), severe hypertension (p≤0.01), and pre-eclampsia (p<0.001).


CONCLUSIONS
Women in 'tight' (vs. 'less tight') control were equally satisfied with their care, and more so in the face of adverse perinatal or maternal outcomes.
Obstetrics and Gynaecology, University of British Columbia, Canada.
Marianne
M
Vidler
Medicine, University of British Columbia, Canada. Electronic address: LMagee@sgul.ac.uk.
Laura A
LA
Magee
Medicine, University of British Columbia, Canada.
Peter
P
von Dadelszen
Medicine and Obstetrics and Gynaecology, University of Montreal, Canada.
Evelyne
E
Rey
Obstetrics and Gynaecology, University of Alberta, Canada.
Susan
S
Ross
Pediatrics, University of Toronto, Canada; Obstetrics and Gynaecology, University of Toronto, Canada; The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Canada.
Elizabeth
E
Asztalos
Obstetrics and Gynaecology, University of Toronto, Canada; The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Canada.
Kellie E
KE
Murphy
Medicine, University of British Columbia, Canada.
Jennifer
J
Menzies
The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Canada.
Johanna
J
Sanchez
School of Population and Public Health, University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada.
Joel
J
Singer
Clinical Epidemiology and Biostatistics, McMaster University, Canada.
Amiram
A
Gafni
Obstetrics and Gynaecology, University of Ottawa, Canada.
Andrée
A
Gruslin
Obstetrics and Gynaecology, University of Manitoba, Canada.
Michael
M
Helewa
Obstetrics and Gynaecology, McMaster University, Canada.
Eileen
E
Hutton
Pediatrics, University of Toronto, Canada.
Shoo K
SK
Lee
Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care Research Institute, UBC, Vancouver, Canada.
Terry
T
Lee
Medicine, University of Toronto, Canada.
Alexander G
AG
Logan
Obstetrics and Gynaecology, University of Amsterdam, Netherlands.
Wessel
W
Ganzevoort
Obstetrics and Gynaecology, Derriford Hospital, United Kingdom.
Ross
R
Welch
Obstetrics and Gynaecology, University of Nottingham, United Kingdom.
Jim G
JG
Thornton
Obstetrics and Gynaecology, Université de Sherbrooke, Canada.
Jean-Marie
JM
Moutquin
D000328:Adult; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D046110:Hypertension, Pregnancy-Induced / Q000188:drug therapy / Q000503:physiopathology; D017060:Patient Satisfaction; D011247:Pregnancy; D011295:Prenatal Care; D011795:Surveys and Questionnaires
D000959:Antihypertensive Agents
Blood pressure control; Hypertension; Postpartum; Pregnancy; Satisfaction