A recent study developed a new “digital companion” to support the prevention and follow-up of maternal cardiovascular risk in women with pregnancy complications.

Cardiovascular disease, or CVD, is the leading cause of premature death and illness in women, yet sex-specific causes remain understudied and women are underrepresented in research.

Pregnancy complications, including hypertensive disorders of pregnancy, or HDP, and gestational diabetes mellitus, or GDM, are strong predictors of future CVD, with pregnancy itself acting as a natural stress test.

Despite CVD accounting for 35 per cent of female deaths worldwide in 2019, systematic postpartum prevention remains limited in practice and incidence continues to rise.

Myocardial infarction, commonly known as heart attack, and stroke are the main fatal CVD events in women. Up to one-third of women develop hypertension within a decade after HDP, especially as maternal age rises.

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 personalised approaches, such as periodic hypertension and diabetes screening. Norwegian guidelines recommend cardiovascular risk evaluation at three months and one 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 opportunity to engage women in cardiovascular health management, particularly as pregnancy can encourage long-term lifestyle awareness.

Electronic health, or eHealth, refers to the use of digital technologies and electronic communication tools to support healthcare services, medical information management and related health activities.

Systematic, eHealth-supported postpartum prevention can improve maternal health literacy and 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 shows promise, but broader digital support remains limited.

A cardiovascular postpartum follow-up programme was created as a mobile app based on Norwegian and international guidelines.

The MumCare app was developed through co-creation involving users, stakeholders and clinical experts. Five qualitative interviews and 10 user testing sessions informed improvements.

This study primarily analysed 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 also helped turn ideas into 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 provided user perspectives and took part 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 prioritises security and privacy, using encryption, de-identification and two-factor authentication.

User data is stored securely on the app and, for research purposes and with consent, on a dedicated University of Oslo server in line with GDPR and Norwegian regulations.

A linear Stage-Gate model structured the co-creation process, dividing it into phases with quality checkpoints reviewed in project meetings.

This approach balanced internal development with external user feedback, helping ensure the app is evidence-based, technically robust and user-centred.

The MumCare app guides postpartum women through tracking blood pressure, weight, physical activity and lab results, and provides personalised feedback to support self-management, mainly during the first postpartum year.

It also includes educational resources such as videos and guideline-based information to support 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 described 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 development.

In phase 1, input from expert organisations and user representatives established the app’s technical foundation.

It also reminds users of the one-year postpartum follow-up with their GP, a key time to assess risk factors and future care needs.

User organisation representatives gave feedback in phase 1, directly guiding content and feature development.

Phase 2 interviews confirmed that 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 more personalised approach to blood pressure monitoring in the app.

Concerns were also raised that frequent monitoring or app use could increase stress or create a sense of burden.

In phase 3, the app’s design and features were revised in response to feedback to improve usability and make sure 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, followed by further refinements 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.

The MumCare app was co-created with input from experts, user organisations and patients over four phases.

Early expert and organisational contributions helped define the app’s goals, while ongoing feedback from patients helped ensure the design and content reflected 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 randomised controlled clinical trial that began in June 2024, with results needed to determine whether it improves long-term cardiovascular outcomes.