Berks D, Hoedjes M, Raat H, Franx A, Looman C W N, Van Oostwaard M F, Papatsonis D N M, Duvekot J J, Steegers E A P
Erasmus MC, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands.
Erasmus MC, Department of Public Health, Rotterdam, The Netherlands.
Pregnancy Hypertens. 2019 Jan;15:98-107. doi: 10.1016/j.preghy.2018.12.004. Epub 2018 Dec 11.
To evaluate the feasibility and effectiveness of a postpartum lifestyle intervention after pregnancies complicated by preeclampsia, fetal growth restriction (FGR) and/or gestational diabetes mellitus (GDM) to improve maternal risk factors for future cardiometabolic disease.
Women following a complicated pregnancy were included six months postpartum in this specific pre-post controlled designed study. It has been conducted in one tertiary and three secondary care hospitals (intervention group) and one secondary care hospital (control group). The program consisted of a computer-tailored health education program combined with three individual counselling sessions during seven months. Primary outcome measures were the proportion of eligible women and weight change during the intervention.
Two hundred and six women were willing to participate. The proportion of eligible women who complied with the intervention was 23%. Major barrier was lack of time. Adjusted weight change attributed to lifestyle intervention was -1.9 kg (95%-CI -4.3 to -0.3). Further changes were BMI (-0.9 kg/m (95%-CI -1.4 to -0.3)), waist-to-hip ratio (-0.04 cm/cm (95%-CI -0.06 to -0.03)), blood pressure medication use (19% (95%-CI 9% to 28%)), HOMA2-score (59 %S (95%-CI 18 to 99)) and total fat intake (-2.9 gr (95%-CI -4.6 to -1.2)).
The results support feasibility and effectiveness of a lifestyle intervention after complicated pregnancies to improve maternal cardiometabolic risk factors. Further randomized controlled studies are needed with longer follow-up to evaluate durability. In the meantime, we suggest health care professionals to offer lifestyle interventions to women after complicated pregnancies.
评估子痫前期、胎儿生长受限（FGR）和/或妊娠期糖尿病（GDM）合并妊娠产后生活方式干预对改善未来心血管代谢疾病孕产妇风险因素的可行性和有效性。
在这项特定的前后对照设计研究中，纳入了产后6个月有复杂妊娠史的女性。研究在一家三级医院和三家二级护理医院（干预组）以及一家二级护理医院（对照组）进行。该项目包括一个计算机定制的健康教育项目，并在7个月内进行三次个体咨询。主要结局指标是符合条件的女性比例和干预期间的体重变化。
206名女性愿意参与。符合干预条件并实际参与的女性比例为23%。主要障碍是时间不足。生活方式干预导致的体重调整变化为-1.9千克（95%置信区间-4.3至-0.3）。其他变化包括体重指数（-0.9千克/米²（95%置信区间-1.4至-0.3））、腰臀比（-0.04厘米/厘米（95%置信区间-0.06至-0.03））、使用降压药物的情况（19%（95%置信区间9%至28%））、HOMA2评分（59%（95%置信区间18至99））和总脂肪摄入量（-2.9克（95%置信区间-4.6至-1.2））。
结果支持复杂妊娠后进行生活方式干预以改善孕产妇心血管代谢风险因素的可行性和有效性。需要进一步进行随访时间更长的随机对照研究来评估其持久性。同时，我们建议医疗保健专业人员为有复杂妊娠史的女性提供生活方式干预。
