Randomized Trial to Reduce Cardiovascular Risk in Women with Recent Preeclampsia

Rich‐Edwards, Janet W.; Stuart, Jennifer; Skurnik, Géraldine; Roche, Andrea T.; Tsigas, Eleni; Fitzmaurice, Garrett M.; Wilkins‐Haug, Louise; Levkoff, Sue E.; Seely, Ellen W.

doi:10.1089/jwh.2018.7523

Cited by 79 publications

(107 citation statements)

References 34 publications

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“…Therefore, future trials should consider the use of an objective assessment of physical activity, such as accelerometers, to better assess this outcome. This is consistent with the findings and conclusions of Rich-Edwards et al [38] who, despite demonstrating significant changes in physical inactivity, were unable to detect any subsequent changes in physical activity levels.…”

Section: Preliminary Efficacysupporting

confidence: 92%

“…Comparatively, the one other published RCT to have evaluated a CVD lifestyle prevention intervention for women following preeclampsia recruited 151 women with preeclampsia within the past five years over an 11-month period from across the United States using websites and social media. They had 1493 women express interest in participating, most of whom were deemed ineligible (n = 871), while others declined participation (n = 43), were lost to follow-up (n = 167) or did not complete the recruitment process as the target sample size for the study was achieved (n = 260) [38]. Overall, the findings from the RCT provide support for the recruitment materials and strategies utilized in the study.…”

Section: Participant Recruitment and Retentionmentioning

confidence: 84%

“…However, there were moderate effect sizes for total cholesterol (−0.58), LDL-C (−0.56), polyunsaturated fatty acid intake (0.51), sodium intake (−0.62) and resistance-based exercise (−0.75) suggesting potential for positive impacts of the intervention on health behaviors and CVD biomarkers. In one similar trial conducted to date, Rich-Edwards et al compared the impact of web-based lifestyle intervention Heart Health 4 Moms (HH4M) vs. general online information (control group) on CVD risk factors in American women (n = 151) with a history of preeclampsia [38]. At nine months, women in the intervention group reported a significant increase in knowledge of CVD risk factors (p = 0.01) and self-efficacy for health eating (p = 0.03) and a reduction in sedentary behavior (p = 0.0006), but found no differences in physical activity levels, DASH diet score, blood pressure of weight between groups [38].…”

Section: Preliminary Efficacymentioning

confidence: 99%

“…In one similar trial conducted to date, Rich-Edwards et al compared the impact of web-based lifestyle intervention Heart Health 4 Moms (HH4M) vs. general online information (control group) on CVD risk factors in American women (n = 151) with a history of preeclampsia [38]. At nine months, women in the intervention group reported a significant increase in knowledge of CVD risk factors (p = 0.01) and self-efficacy for health eating (p = 0.03) and a reduction in sedentary behavior (p = 0.0006), but found no differences in physical activity levels, DASH diet score, blood pressure of weight between groups [38]. Notably, the current study also demonstrated a moderate effect size for physical activity (−0.57), however results favored the control group.…”

Section: Preliminary Efficacymentioning

confidence: 99%

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Be Healthe for Your Heart: A Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women with a History of Preeclampsia

Hutchesson

Taylor

Shrewsbury

et al. 2020

IJERPH

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This pilot randomized controlled trial (RCT) aimed to determine the acceptability and preliminary efficacy of a web-based cardiovascular disease (CVD) prevention intervention for women following preeclampsia. Australian women with a recent history (≤4 years post diagnosis) of preeclampsia were randomized into two study arms: (1) Be Healthe for your Heart, a web-based behavioral intervention or; (2) Control, access to the National Heart Foundation website. Assessments were conducted at baseline, and after three months. Intervention acceptability and impact on absolute CVD 30-year risk score, CVD risk markers and health behaviors were assessed. Twenty-four of 31 (77.4%) women completed the three-month assessment. Eleven out of 13 intervention participants (84.6%) agreed/strongly agreed they were satisfied with the program, with a mean score of 4.2 ± 0.9 (maximum of five). There were no significant between or within group differences in absolute CVD risk, CVD risk markers or health behaviors from baseline to three months. Women with a history of preeclampsia were successfully recruited and retained and they reported high levels of acceptability with the Be Healthe for your Heart program. Further research is therefore needed from powered trials to determine the impact of web-based lifestyle interventions on CVD risk in this at-risk group.

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Section: Preliminary Efficacysupporting

confidence: 92%

Section: Participant Recruitment and Retentionmentioning

confidence: 84%

Section: Preliminary Efficacymentioning

confidence: 99%

Section: Preliminary Efficacymentioning

confidence: 99%

See 2 more Smart Citations

Be Healthe for Your Heart: A Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women with a History of Preeclampsia

Hutchesson

Taylor

Shrewsbury

et al. 2020

IJERPH

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“…To date, limited research has evaluated the efficacy of different intervention approaches addressing cardiovascular health post pregnancy for women with a history of preeclampsia. To the authors' knowledge there has been one recent trial published from the United States (11) and another currently underway in Australia (12). Therefore, the aim of this pilot randomized controlled trial (RCT) is to determine the acceptability and preliminary efficacy of a web-based lifestyle behavioral intervention targeted to women with a recent history of preeclampsia (Be Healthe for your Heart).…”

Section: Introductionmentioning

confidence: 99%

Be Healthe for Your Heart: Protocol for a Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women With a History of Preeclampsia

Taylor

Shrewsbury

Vincze

et al. 2019

Front. Cardiovasc. Med.

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Background: Women with a history of preeclampsia are at greater risk of cardiovascular disease (CVD) related morbidity. Despite this knowledge, there is a lack of interventions available for women with a history of preeclampsia for the prevention of CVD. The aim of this pilot randomized controlled trial (RCT) is to determine the acceptability and preliminary efficacy of a web-based behavioral intervention targeted to women with a history of preeclampsia (Be Healthe for your Heart).Method: Australian women aged 18–45 years, with a recent history (≤4 years post diagnosis) of preeclampsia will be recruited for a 3-months, 2-arm parallel group pilot RCT. Participants will be randomized into 2 study arms: (1) Be Healthe for your Heart or; (2) Control, with assessments conducted at baseline, and after 3-months. Be Healthe for your Heart is an intervention delivered online via the program website, with weekly emails to support changes in modifiable CVD risk factors (excess body weight, physical inactivity, poor diet, and stress), using behavior change techniques (e.g., self-monitoring, goal setting). Intervention acceptability (satisfaction, usability, appropriateness, and usage) and impact on absolute full CVD 30-years risk score, CVD risk markers, and modifiable risk factors will be assessed.Discussion: No studies to date have evaluated acceptability and preliminary efficacy of a web-based intervention for the prevention of CVD in this high-risk population with preeclampsia. This pilot trial will inform development of a fully powered RCT if acceptability and preliminary efficacy are demonstrated.

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Interventions to Mitigate Risk of Cardiovascular Disease After Adverse Pregnancy Outcomes

et al. 2022

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IMPORTANCE A growing body of evidence suggests that adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy, gestational diabetes (GD), preterm birth, and intrauterine growth restriction, are associated with increased risk of cardiometabolic disease and cardiovascular disease (CVD) later in life. Adverse pregnancy outcomes may therefore represent an opportunity to intervene to prevent or delay onset of CVD. The objective of this review was to summarize the current evidence for targeted postpartum interventions and strategies to reduce CVD risk in women with a history of APOs.OBSERVATIONS A search of PubMed and Ovid for English-language randomized clinical trials, cohort studies, descriptive studies, and guidelines published from January 1, 2000, to April 30, 2021, was performed. Four broad categories of interventions were identified: transitional clinics, lifestyle interventions, pharmacotherapy, and patient and clinician education. Observational studies suggest that postpartum transitional clinics identify women who are at elevated risk for CVD and may aid in the transition to longitudinal primary care. Lifestyle interventions to increase physical activity and improve diet quality may help reduce the incidence of type 2 diabetes in women with prior GD; less is known about women with other prior APOs. Metformin hydrochloride may prevent development of type 2 diabetes in women with prior GD. Evidence is lacking in regard to specific pharmacotherapies after other APOs. Cardiovascular guidelines endorse using a history of APOs to refine CVD risk assessment and guide statin prescription for primary prevention in women with intermediate calculated 10-year CVD risk. Research suggests a low level of awareness of the link between APOs and CVD among both patients and clinicians.CONCLUSIONS AND RELEVANCE These findings suggest that transitional clinics, lifestyle intervention, targeted pharmacotherapy, and clinician and patient education represent promising strategies for improving postpartum maternal cardiometabolic health in women with APOs; further research is needed to develop and rigorously evaluate these interventions. Future efforts should focus on strategies to increase maternal postpartum follow-up, improve accessibility to interventions across diverse racial and cultural groups, expand awareness of sex-specific CVD risk factors, and define evidence-based precision prevention strategies for this high-risk population.

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Randomized Trial to Reduce Cardiovascular Risk in Women with Recent Preeclampsia

Cited by 79 publications

References 34 publications

Be Healthe for Your Heart: A Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women with a History of Preeclampsia

Be Healthe for Your Heart: A Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women with a History of Preeclampsia

Be Healthe for Your Heart: Protocol for a Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women With a History of Preeclampsia

Interventions to Mitigate Risk of Cardiovascular Disease After Adverse Pregnancy Outcomes

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