Introduction Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication.¹ We intended to codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension that consisted of both a patient decision aid and a conversation aid.

Methods Setting and Participants: Pregnant women with chronic hypertension and their principal healthcare professionals (obstetricians, midwives, and physicians), at three National Health Service hospital trusts with different models of care. Main outcome measures: The RE-AIM framework guided the evaluation. Primary: Decisional conflict scale, medication intention survey and women’s acceptability. Secondary: Healthcare professionals’ acceptability and the barriers and facilitators to SDM implementation with pregnant women with chronic hypertension. Results

Fifty women participated Nearly half (46%; n=23) of women were from Black and Asian backgrounds. The SDM intervention was effective at reducing decisional conflict (mean reduction from baseline 42%, 95% CI 35–49, p≤0.05). In 36 women (72%), the reduction was of clinical importance. 24 women (48%) were uncertain about or planned not to take antihypertensives prior to the SDM intervention, compared to two women (4%) after the intervention. The intervention was acceptable to women and healthcare professionals. 10 of 14 healthcare professionals felt that the conversation aid facilitated SDM in current antenatal contexts, a similar proportion (10/14) felt the length of consultations hindered SDM. The intervention has been endorsed by NICE and National Implementation is being co-designed with NHS England.

Conclusion A novel codesigned SDM intervention reduced decisional conflict and increased women’s intention to take antihypertensive agents during pregnancy. This intervention could be adopted into practice for women making pregnancy decisions where there is uncertainty around the medication management option.

Reference

1. Whybrow R, Webster L, Girling J, Brown H, Wilson H, Sandall J, Chappell L. Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study. BMJ Open. 2020:Oct 23;10(10):e035762. doi: 10.1136/bmjopen-2019-035762. PMID: 33099489; PMCID: PMC7590365.