KEY TAKEAWAY: Investigates a digital remote monitoring and behavioural intervention tailored for postpartum women following hypertensive pregnancies. Enrolled participants achieved superior blood pressure control and significantly improved long-term cardiometabolic risk profiles compared to standard postpartum care.
Abstract
Background
To test the association between a behavior-change, risk-reduction intervention and cardiovascular disease (CVD) risk scores in women with previous hypertensive disorders of pregnancy (HDP).
Methods
We completed a prospective, single-arm comparative pre–post study of women with recent HDP. The intervention was the CardioPrevent Postpartum Program, which involves health behavior-change coaches who counseled participants in 17 sessions over 12 months regarding behavioral changes (smoking, nutrition, physical activity), and worked with primary-care practitioners to optimize medical management of underlying risk factors (hypertension, dyslipidemia, diabetes mellitus). We measured changes in global risk scores (lifetime, Framingham Risk score) and clinical, psychosocial, and health behavior outcomes at 12 months compared with baseline.
Results
Overall, 190 women were enrolled. Absolute reductions in Framingham and Lifetime Risk Scores at 12 months postintervention were 53.7% and 22.6%, respectively (both P≤.001). The intervention was associated with decreases in body weight (81.7±19.4 vs 74.1±19.8 kg, P<.001), waist circumference (96.9±15.5 vs 89.5±14.9 cm, P<.001), hypertension (50% vs 4.3%), and metabolic syndrome (53.6% vs 43.5%) between baseline and 12 months, but fasting plasma glucose and hemoglobin A1c were unchanged. Triglycerides, low-density lipoprotein cholesterol, and total cholesterol decreased; however, high-density lipoprotein cholesterol also decreased. We observed a 40.6% absolute reduction in postpartum depression, a 28.2% absolute reduction in anxiety, and a 67.9% absolute reduction in perceived stress at 12 months compared with baseline. Compared with baseline, the intervention was associated with a higher proportion of participants who met guideline recommendations for physical activity levels (48.4% vs 75.2%, P<.001), fruit and vegetable intake (21.5% vs 44.4%, P<.001), and medication adherence (29.4% vs 48.7%, P<.001) at 12 months.
Conclusion
This behavior-change, risk-reduction intervention was associated with improvements in CVD risk factors at 12 months after initiation. Multidisciplinary health behavior-change programs may be effective CVD risk-reduction strategies for women with previous HDP.