Effectiveness of a Multicomponent Nurse-Led Intervention on Maternal and Perinatal Outcomes among Pregnant Women with Hypertensive Disorders of Pregnancy: A Quasi-Experimental Study

Abstract

Background: Maternal and perinatal morbidity and mortality are significant due to hypertensive disorders of pregnancy (HDP). The clinical management of an antenatal situation must be accompanied by antenatal education, medication compliance and advice on diet and lifestyle, as well as psychological support. The holistic nurse-led approach can help reinforce maternal self-care practices and help to improve pregnancy outcomes.

Aim: This is a study to assess the effectiveness of a multimodal nurse-led intervention on knowledge, physiological parameters, maternal stress and maternal & perinatal outcomes for women with hypertensive disorders in pregnancy.

Methods: The study was designed as a quantitative quasi-experimental one group pre test–post test design and selected pregnant women with HDP (n=66) of the study were recruited from selected healthcare centres of Deshapran block, Purba Medinipur district, West Bengal. The participants were selected through purpose sampling at the 24-28th week of gestation. The multicomponent 8-weeks nurse-led intervention comprised of structured maternal education, dietary counselling, blood pressure monitoring, medication adherence counselling, lifestyle modification, mindful walking, Pranava Pranayama, guided mindful meditation, and regular follow-up with reinforcement. Before and after the intervention, knowledge, physiological parameters and maternal stress were evaluated, and after childbirth, maternal and perinatal outcomes were assessed.

Results: The mean difference between pretest and posttest scores for knowledge was 11.12, and the paired t value was statistically significant (p < 0.001) with mean knowledge score pretest 6.74 ± 2.08 and posttest 17.86 ± 1.42. There was notable improvement in blood pressure (systolic blood pressure, diastolic blood pressure), proteinuria, edema, headache and epigastric pain for all comparisons (p < 0.001). There was a significant positive correlation between posttest knowledge and maternal outcomes (r = 0.62, p = 0.001) and fetal/neonatal outcomes (r = 0.62, p = 0.001). Maternal and fetal/neonatal outcomes were negatively correlated with systolic and diastolic blood pressure (r = −0.66, p = 0.001). Maternal stress also had significant negative correlations with maternal outcomes (r = −0.58, p = 0.003) and fetal/neonatal outcomes (r = −0.58, p < 0.001).

Conclusion: There were significant positive associations between the multicomponent nurse-led intervention and maternal knowledge and selected physiological parameters of pregnant women with HDP. The results also reveal strong relationships between maternal knowledge, blood pressure, stress and maternal and fetal/neonatal outcomes. Comprehensive nurse-led education, clinical monitoring, lifestyle support and stress-management techniques could be a helpful supportive measure in the community-based antenatal care for women with HDP. Larger samples and controlled designs in multicentre studies are warranted to confirm these findings.