Blood pressure postpartum (BP2) RCT protocol: Follow-up and lifestyle behaviour change strategies in the first 12 months after hypertensive pregnancy

Henry, Amanda; Arnott, Clare; Makris, Angela; Davis, Gregory K.; Hennessy, Annemarie; Beech, Amanda; Pettit, Franziska; Homer, Caroline; Craig, Maria E.; Roberts, Lynne M.; Hyett, Jon; Chambers, Georgina M.; Fitzgerald, Oisín; Gow, Megan L.; Mann, Linda; Challis, Daniel; Gale, Marianne; Ruhotas, Annette; Kirwin, Emilee; Denney‐Wilson, Elizabeth; Brown, Mark

doi:10.1016/j.preghy.2020.07.001

Cited by 19 publications

(30 citation statements)

References 28 publications

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“…This model has been adopted across a number of sites worldwide in the last decade, and in recent years, a number of research-based postpartum interventions have also been developed. However, these research-based interventions are often opt-in research studies rather than routine outpatient care, tend to focus on specific complications of pregnancy, such as preeclampsia (15)(16)(17)(18), and the effectiveness of these interventions at reducing cardiovascular and metabolic disease risk has not been rigorously assessed in a real-world clinic setting. The first nurse-led postpartum clinic in Australia was introduced in 2018 at the Lyell McEwin Hospital and aims to provide structured lifestyle and risk education (19).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis

Aldridge

Pathirana

Wittwer

et al. 2022

Front. Cardiovasc. Med.

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IntroductionCertain complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, spontaneous preterm birth, and placental abruption, are established independent risk factors for premature cardiovascular disease in women. Metabolic syndrome, which is associated with an increased risk of cardiovascular disease, may be a suitable alternative to traditional cardiovascular risk calculators that underestimate risk in young women. This study aimed to investigate the prevalence of metabolic syndrome in women who experienced a complicated pregnancy 6 months earlier.MethodsThis observational study investigated the prevalence of metabolic syndrome as defined by the International Diabetes Federation in all eligible participants (n = 247) attending a postpartum lifestyle intervention clinic from August 2018 to June 2021 at the Lyell McEwin Hospital in Adelaide, South Australia.ResultsA total of 89 (36%) participants met the criteria for metabolic syndrome at a mean follow up time of 7 months postpartum. Almost 90% of the cohort were abdominally obese, and over two thirds of the total cohort met at least two of the criteria for metabolic syndrome.ConclusionsWomen with a prior history of one of the common major pregnancy complications are at high risk of future cardiovascular and metabolic disease, with many showing either metabolic syndrome or multiple risk factors at only 7 months postpartum. The results indicate that follow-up within 1 year postpartum is an appropriate time to commence preventative strategies, as many women are already showing early signs of disease.

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Section: Introductionmentioning

confidence: 99%

Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis

Aldridge

Pathirana

Wittwer

et al. 2022

Front. Cardiovasc. Med.

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“…Additional trials are currently underway that may provide further guidance on the efficacy and implementation of post-partum follow-up care for CVD prevention. 138 journals.sagepub.com/home/reh…”

Section: Post-partum Follow-up Carementioning

confidence: 99%

A review of maternal overweight and obesity and its impact on cardiometabolic outcomes during pregnancy and postpartum

Grieger

Hutchesson

Cooray

et al. 2021

Clin Med�Insights�Reprod�Health

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The rates of maternal overweight and obesity, but also excess gestational weight gain, are increasing. Pregnancy complications, including gestational diabetes mellitus, gestational hypertension, pre-eclampsia and delivery of a preterm or growth restricted baby, are higher for both women with overweight and obesity and women who gain excess weight during their pregnancy. Other conditions such as polycystic ovary syndrome are also strongly linked to overweight and obesity and worsened pregnancy complications. All of these conditions place women at increased risk for future cardiometabolic diseases. If overweight and obesity, but also excess gestational weight gain, can be reduced in women of reproductive age, then multiple comorbidities associated with pregnancy complications may also be reduced in the years after childbirth. This narrative review highlights the association between maternal overweight and obesity and gestational weight gain, with gestational diabetes, pre-eclampsia, polycystic ovary syndrome and delivery of a preterm or growth restricted baby. This review also addresses how these adverse conditions are linked to cardiometabolic diseases after birth. We report that while the independent associations between obesity and gestational weight gain are evident across many of the adverse conditions assessed, whether body mass index or gestational weight gain is a stronger driving factor for many of these is currently unclear. Mechanisms linking gestational diabetes mellitus, gestational hypertension, pre-eclampsia, preterm delivery and polycystic ovary syndrome to heightened risk for cardiometabolic diseases are multifactorial but relate to cardiovascular and inflammatory pathways that are also found in overweight and obesity. The need for post-partum cardiovascular risk assessment and follow-up care remains overlooked. Such early detection and intervention for women with pregnancy-related complications will significantly attenuate risk for cardiovascular disease.

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“…To address this problem, a three-arm, randomised trial of lifestyle behaviour change strategies in the first 12 months after HDP is currently underway. 16 Women are randomised postpar- A structured, comprehensive postpartum cardiovascular screening and management program based on existing guidelines for asymptomatic people was proposed by Spaan et al 17 (Table 1). In this model, women with a history of HDP…”

Section: How Can We Reduce the Risk Of Later Cvd?mentioning

confidence: 99%

The long‐term cardiovascular impact of hypertension in pregnancy – A missed opportunity

Davis¹,

Henry

Arnott

et al. 2021

Aust NZ J Obst Gynaeco

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Women who have had hypertension in pregnancy, both pre-eclampsia and gestational hypertension, have a two-to three-fold increased risk of cardiovascular disease later in life. It is unclear whether this is an unmasking of latent risk, the result of damage to the vascular tree during pregnancy, or both. Irrespective of the underlying pathophysiology, these women are uniquely identified sufficiently early in their lives for lifestyle interventions, if adopted, to improve their long-term health. Currently, follow-up of these women is inadequate and implementation of a coordinated follow-up program, and further research into how best to provide it, is urgently needed.

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Blood pressure postpartum (BP2) RCT protocol: Follow-up and lifestyle behaviour change strategies in the first 12 months after hypertensive pregnancy

Cited by 19 publications

References 28 publications

Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis

Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis

A review of maternal overweight and obesity and its impact on cardiometabolic outcomes during pregnancy and postpartum

The long‐term cardiovascular impact of hypertension in pregnancy – A missed opportunity

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