Pregnancy is physiologically complicated. The cascade of changes that take place in a pregnant person’s body during almost 10 months of gestation can lead to new health conditions or exacerbate existing ones. Some conditions — such as preeclampsia — can put both mother and baby at heightened risk of morbidity and mortality. In many cases, preeclampsia resolves at childbirth. But for some patients, the “fourth trimester,” or the period immediately following the birth of their child, is also a perilous time. Postpartum hypertension and postpartum preeclampsia — conditions in which a patient experiences high blood pressure in the days or weeks after giving birth — account for about 10 percent of maternal deaths.
Ann Celi, MD, MPH, one of the program leaders of the Brigham’s Cardiometabolic Clinic in Maternal Fetal Medicine, is passionate about helping patients during this critical window. The clinic’s team focuses on the transition from obstetric to primary care after hypertensive pregnancies.
“Our goal is to empower patients,” said Celi. “Ten years ago, we opened our doors and our ears to the issues that postpartum women and persons face at this vulnerable time.”
Based on what she and her colleagues learned, they have shaped their program into a collaborative, interdisciplinary clinic that puts the needs of patients at its center.
Navigating Postpartum Crises
Rosviny Felix had a challenging pregnancy. For eight months, she experienced hyperemesis gravidarum — persistent and debilitating nausea that led to weight loss and anemia. While the birth of her child at another hospital was uncomplicated, Felix’s health challenges continued. After receiving a diagnosis of postpartum preeclampsia, Felix researched the condition online and found Celi and the Cardiometabolic Clinic at the Brigham.
“Dr. Celi took my case and a few days later, I paged her — I was having a hypertensive crisis,” Felix recalls. After hearing Felix’s symptoms, Celi told her to go the Emergency Department immediately. Celi then worked hand-in-hand with the ED care team to make sure Felix received the care she needed.
“I’ve never had a doctor care so much about my health,” said Felix. “From the beginning, she was there for me. She would call me outside of work hours saying, ‘Hey, I just made dinner, but I wanted to see how your blood pressure is.’ And every time I spoke to her, I felt like her equal.”
Amanda Seider also recalls after-hours calls from Celi. Celi treated Seider during her first pregnancy during which she experienced preeclampsia. Seider did not have preeclampsia during her second pregnancy, but five days after giving birth, her blood pressure began climbing.
“I didn’t know this was coming, but I knew who to call,” said Seider. “Dr. Celi and her team took great care of me with honesty and support. Dr. Celi was always willing to hop on the phone. I felt like I had a person — a scientist, a physician but also a person — who was there to help me navigate this dramatic experience.”
At the MFM Cardiometabolic Clinic, Celi delivers highly specialized care and health education for her patients. The clinic also closely collaborates with specialists in nephrology, cardiology, nutrition, psychiatry, social work and endocrinology to coordinate and address their patients’ care needs.
Felix especially appreciated Celi’s thoughtfulness and thoroughness when connecting her with new physicians.
“When I’ve met with doctors, they already know all about me, which I love,” said Felix. “I feel lucky I found Dr. Celi. If I hadn’t, my story could be very different today.”
Championing Care and Racial Justice
The Cardiometabolic Clinic is a collaborative program between the Department of Medicine, the Department of Obstetrics and Gynecology and the Division of Maternal Fetal Medicine. The clinic was conceived by an interdisciplinary group of clinical leaders including Louise E. Wilkins Haug, MD, PhD, director of Maternal Fetal Medicine, Ellen Seely, MD, vice chair of Faculty Development in the Department of Medicine and Division of Endocrinology, as well as Celi and the Departments of Medicine and Primary Care leadership.
“Our vision was that with growing data, we could find strategies to help women with preeclampsia who went on to have health care issues,” said Celi, “And we could figure out how to get better care for them.”
In 2010, Celi and colleagues competed for an Innovator Award to receive initial funding for the clinic. While the project did not win, the competition brought visibility to their vision. Joseph Loscalzo, MD, PhD, chair to the Department of Medicine, along with the primary care leadership, invested in the team’s novel idea in a collaborative effort with Maternal Fetal Medicine.
The clinic opened its doors in 2011 and within months, the program was financially sustainable and has become a permanent program that includes education and support for residents, fellows and faculty. Since the clinic’s doors opened more than 10 years ago, over 1,000 women have received care there. The clinic focuses on helping patients transition from obstetric to primary care. With 33 percent Black patients and 26.5 percent Hispanic, the clinic’s patient population is racially and socioeconomically diverse. Celi and the team are dedicated to helping women of color and those on public assistance.
Early on, Celi recognized that home blood pressure monitoring was critical for patient empowerment. Over its first five years of operation, the clinic increased access to blood pressure monitors for patients to use at home after hypertensive pregnancy, reaching 94 percent of patients, and pairs this with in-clinic discussions about home blood pressure monitoring, nutrition and heart-healthy lifestyles.
Most recently, Celi was selected as a phase 1 awardee of the Hypertension Innovator Award Competition by the U.S. Department of Health and Human Services (HHS) for her work improving outcomes and empowering patients after hypertensive pregnancy. She was also recognized by the Terrapin Foundation for clinical care and excellence.
“Our clinic has become a champion of racial and maternal justice and has been recognized as such nationally and internationally,” said Celi. “This award is a validation of the mission that drives us.”
Seider, who is Black, applauds the clinic’s commitment to providing high-quality care to everyone.
“Clinics like this should be part of the plan,” said Seider. “In a better world, there would be access to more physicians like Dr. Celi and to teams from so many different disciplines to come together to support the health of patients and their babies.”