Feasibility of a Postpartum Web- and Phone-Based Lifestyle Program for Women with a History of Preeclampsia or Gestational Diabetes: A Pilot Intervention Study.

Background: Women with a history of preeclampsia (PE) or gestational diabetes mellitus (GDM) are at increased risk of diabetes and cardiovascular disease (CVD) later in life. Increased awareness of pregnancy complications as early warning signs for CVD has called for postpartum primordial prevention strategies. The aim of this study was to evaluate the feasibility of a postpartum web- and phone-based lifestyle program promoting healthy lifestyle behaviors to women after a pregnancy complicated by PE or GDM. Materials and Methods: Women with a validated history of PE or GDM were invited to participate in a nonrandomized pilot intervention study 3-12 months after delivery. The intervention was delivered over 6 months. All participants received tailored lifestyle counseling by a registered dietitian and access to information material on healthy lifestyle behaviors on the study's website. After inclusion, participants were invited to three study visits at baseline, 3 months, and 6 months. Feasibility outcomes included assessment of recruitment, retention, and acceptability. Secondary outcomes were changes in lifestyle behaviors and cardiovascular risk factors. Results: Of the 207 women invited, 44 were enrolled in the feasibility study and 40 women completed the intervention, corresponding to a recruitment rate of 21% and a retention rate of 91%. At the 3-month study visit, 94.6% of participants reported they had used the website. A total of 41.7% of the participants reported that they had achieved their personal goals during the intervention period. Conclusions: This study suggested the feasibility and potential acceptability of a web- and phone-based lifestyle intervention for mothers with recent PE or GDM. Clinical Trial Registration: clinicaltrials.gov, www.clinicaltrials.gov, no. NCT03993145.

Cardiovascular risk factors prior to conception and the length of pregnancy: population-based cohort study.

OBJECTIVE: To study the association of prepregnancy blood pressure, lipids, and glucose with length of pregnancy, and to assess whether the association between preterm delivery and later maternal cardiovascular disease may be due to common risk factors. STUDY DESIGN: Prospective study linking information of 3506 women in the HUNT Study with 4990 singleton births recorded in the Medical Birth Registry of Norway. RESULTS: Unfavorable prepregnancy levels of triglycerides, cholesterol, high-density lipoprotein-cholesterol, and glucose were associated with increased risk of preterm birth and shorter gestational length. Triglycerides above 1.6 mmol/L were associated with 60% higher risk of preterm birth (odds ratio, 1.6, 95% confidence interval, 1.0-2.5), compared with triglycerides below 0.7 mmol/L. Blood pressure was positively associated with risk of preterm birth and shorter gestational length, but these associations were substantially attenuated after adjustment for hypertensive disorders in pregnancy. CONCLUSION: Women with unfavorable cardiovascular risk factors before conception have excess risk of preterm birth.

Hypertension in pregnancy and later cardiovascular risk: common antecedents?

BACKGROUND: Preeclampsia and gestational hypertension are associated with increased risk for cardiovascular disease later in life. We have assessed whether the effect can be attributed to factors that operate in pregnancy or to prepregnancy risk factors that are shared by both disorders. METHODS AND RESULTS: Longitudinal data from 2 consecutive waves of a Norwegian population-based study (the Nord-Trøndelag Health Study [HUNT]) were combined with data from the Medical Birth Registry of Norway. Among 24 865 women who had participated in both HUNT 1 and 2, we indentified 3225 women with a singleton birth between the 2 studies who had standardized measurements of blood pressure, serum lipids, and body mass index. The crude results showed that women who experienced preeclampsia or gestational hypertension in pregnancy had substantially higher levels of body mass index and systolic and diastolic blood pressures and unfavorable lipids compared with other women. However, after adjustment for prepregnancy measurements, the difference in body mass index was attenuated by >65%, and the difference in blood pressure was attenuated by approximately 50%. In relation to high-density lipoprotein cholesterol and triglycerides, differences between the groups were attenuated by 40% and 72%, respectively. CONCLUSIONS: These results suggest that the positive association of preeclampsia and gestational hypertension with postpregnancy cardiovascular risk factors may be due largely to shared prepregnancy risk factors rather than reflecting a direct influence of the hypertensive disorder in pregnancy.

Hypertensive disorders in pregnancy and subsequently measured cardiovascular risk factors.

OBJECTIVE: To study the association of hypertensive pregnancy disorders with modifiable risk factors for cardiovascular and metabolic diseases and to estimate the feasibility for early detection and prevention. METHODS: This was a prospective study of 15,065 women with a first singleton birth between 1967 and 1995, who later participated in a population study that included standardized measurements of blood pressure, serum lipids, and body mass index (BMI). RESULTS: Women with a history of hypertensive disorders in pregnancy (preeclampsia or gestational hypertension) had higher BMI, higher blood pressure, and unfavorable levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Preeclampsia was associated with substantially higher risk of developing diabetes (odds ratio 3.8, 95% confidence interval [CI] 2.1-6.6), and if the hypertensive disorder occurred in more than one pregnancy, or in a relatively late pregnancy, the associations with later cardiovascular risk factors were substantially stronger. Thus, women with two episodes of preeclampsia were approximately 10 times more likely to use blood pressure medication at follow-up (adjusted odds ratio, 11.6, 95% CI 7.1-26.3), and in women with gestational hypertension in three consecutive pregnancies, systolic pressure was on average 27 mm Hg (95% CI 18-37 mm Hg) higher, and diastolic pressure was 12 mm Hg (95% CI 5-19 mm Hg) higher, compared with women without a history of hypertensive disorders. Adjustment for current body mass index partly attenuated these associations, suggesting that BMI may play an important mediating role. CONCLUSION: Women with a history of hypertensive disorders in pregnancy, and particularly women with recurrent pregnancy disorders, should be candidates for intervention intended to prevent premature cardiovascular disease. LEVEL OF EVIDENCE: II.