The investigator's long-term goal is to mitigate pregnancy-related mortality (PRM) risk by systematically delivering scalable integrated clinical and supportive care that is effective for all. The investigator's central hypothesis is that the Multi-modal Maternal Infant Perinatal Outpatient Delivery System (MOMI PODS) will mitigate postpartum (PP) risk for all by increasing patient engagement with evidence-based cilnical and supportive care, thus improving biopsychosocial profiles that drive clinical risk. To test this hypothesis, the investigators will conduct a hybrid type 1 randomized controlled trial (RCT) of MOMI PODS versus enhanced usual care (EUC, which we will term MOMI CARE) among a total sample of up to 384 mother-infant dyads (192/group) following pregnancy affected by a cardiometabolic and/or mental health condition. The investigators will enroll participants during late pregnancy and collect data at baseline and 6 months and 1 year PP. The investigators will collect implementation and service data across sites.
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Change in Life's Essential 8 (LE8) Composite Score
Timeframe: Baseline (T1) to 6 months postpartum (T2)
Change in Life's Essential 8 (LE8) Composite Score
Timeframe: 6 months postpartum (T2) to 12 months postpartum (T3)
Change in Life's Essential 8 (LE8) Composite Score
Timeframe: Baseline (T1) to 12 months postpartum (T3)
Change in Patient Health Questionnaire-9 (PHQ-9) Score
Timeframe: Baseline (T1) to 6 months postpartum (T2)
Change in Patient Health Questionnaire-9 (PHQ-9) Score
Timeframe: 6 months postpartum (T2) to 12 months postpartum (T3)
Change in Patient Health Questionnaire-9 (PHQ-9) Score
Timeframe: Baseline (T1) to 12 months postpartum (T3)
Change in Generalized Anxiety Disorder-7 (GAD-7) Score
Timeframe: Baseline (T1) to 6 months postpartum (T2)
Change in Generalized Anxiety Disorder-7 (GAD-7) Score
Timeframe: 6 months postpartum (T2) to 12 months postpartum (T3)
Change in Generalized Anxiety Disorder-7 (GAD-7) Score
Timeframe: Baseline (T1) to 12 months postpartum (T3)