Postpartum Lifestyle Intervention Research Articles

OS109. Lifestyle intervention after complicated pregnancy successfully improves saturated fat-intake, but not exercise and smoking habits: results of the pro-active study

Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and/or gestational diabetes are at increased risk of future cardiovascular and metabolic disease. Lifestyle intervention may help these women to effectively lower these risks. To test if offering lifestyle intervention after a complicated pregnancy significantly improves saturated fat-intake and exercise (primary objectives) and/or smoking habits (secondary objective). The Pro-Active study (Postpartum Rotterdam Appraisal of Cardiovascular health and Tailored Intervention) is a feasibility study to develop and evaluate a postpartum lifestyle intervention program. In a prospective case-control setting we tested the effect of the lifestyle intervention. Women were included between April 2007 and August 2009. They were eligible if ⩾18 years old at time of inclusion, being able to understand and speak the Dutch language and not having pre-existing conditions that could interfere with the lifestyle intervention. Cases were offered lifestyle intervention by a trained counsellor between 6 and 10 months postpartum. During 3 private sessions, mainly exercise and fat-intake and to some extend smoking habits were discussed and aims were made to improve lifestyle. Controls did not receive these sessions, but were not restricted to improve lifestyle on their own. Lifestyle habits were scored at 6 and 13 months postpartum. For saturated fat-intake we used the Maastricht Fatlist. For exercise we used the International Physical Activity Questionnaire (IPAQ). For smoking habits we used a short version of the questionnaire of STIVORO (the Dutch anti-smoking association). We also performed a formative evaluation of the intervention program. During our study 1121 women gave birth after a complicated pregnancy. 490 Women were eligible for the study of which 240 women (49%) gave informed consent to participate. 56 Women (23%) were lost-to-follow-up, leaving 186 women for the analysis. Between 6 and 13 months postpartum saturated fat-intake was significantly reduced by 3.6g/day (95%>CI 1.8-5.4) in cases compared to controls. Exercise was improved in cases compared to controls, but it did not reach significance (277 MET's (-2699-3254)). Although smoking decreased from 14.5% to 10.4% in cases, it was not significant and comparable to the decrease in controls (15.0% to 8.4%). The formative evaluation showed that the most important motivator to improve lifestyle was the increased risk of future cardiovascular and metabolic disease (70%) and the increased risk for recurrence in a next pregnancy (57%). Main barriers were an already busy life (40%), distance (35%) and duration (38%) of travelling to the hospital and to early postpartum to pay attention to lifestyle (26%). Lifestyle intervention after complicated pregnancy may be effective in improving saturated fat-intake. Other interventions, specially aimed at postpartum women, are needed to improve exercise and smoking habits. More research is needed to develop lifestyle intervention program specifically aimed at these women. New possibilities of multimedia are promising.

A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors

OBJECTIVETo pilot, among women with gestational diabetes mellitus (GDM), the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program. The intervention was delivered by telephone, and support for breastfeeding was addressed.RESEARCH DESIGN AND METHODSThe goal was to help women return to their prepregnancy weight, if it was normal, or achieve a 5% reduction from prepregnancy weight if overweight. Eligible participants were identified shortly after a GDM diagnosis; 83.8% consented to be randomly assigned to intervention or usual medical care (96 and 101 women, respectively). The retention was 85.2% at 12 months postpartum.RESULTSThe proportion of women who reached the postpartum weight goal was higher, although not statistically significant, in the intervention condition than among usual care (37.5 vs. 21.4%, absolute difference 16.1%, P = 0.07). The intervention was more effective among women who did not exceed the recommended gestational weight gain (difference in the proportion of women meeting the weight goals: 22.5%, P = 0.04). The intervention condition decreased dietary fat intake more than the usual care (condition difference in the mean change in percent of calories from fat: −3.6%, P = 0.002) and increased breastfeeding, although not significantly (condition difference in proportion: 15.0%, P = 0.09). No differences in postpartum physical activity were observed between conditions.CONCLUSIONSThis study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight. Strategies to help postpartum women overcome barriers to increasing physical activity are needed.

Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes

BackgroundWomen who develop gestational diabetes mellitus (GDM) have an increased risk for the development of type 2 diabetes. Despite this "window of opportunity," few intervention studies have targeted postpartum women with a history of GDM. We sought perspectives of women with a history of GDM to identify a) barriers and facilitators to healthy lifestyle changes postpartum, and b) specific intervention approaches that would facilitate participation in a postpartum lifestyle intervention program.MethodsWe used mixed methods to gather data from women with a prior history of GDM, including focus groups and informant interviews. Analysis of focus groups relied on grounded theory and used open-coding to categorize data by themes, while frequency distributions were used for the informant interviews.ResultsOf 38 women eligible to participate in focus groups, only ten women were able to accommodate their schedules to attend a focus group and 15 completed informant interviews by phone. We analyzed data from 25 women (mean age 35, mean pre-pregnancy BMI 28, 52% Caucasian, 20% African American, 12% Asian, 8% American Indian, 8% refused to specify). Themes from the focus groups included concern about developing type 2 diabetes, barriers to changing diet, and barriers to increasing physical activity. In one focus group, women expressed frustration about feeling judged by their physicians during their GDM pregnancy. Cited barriers to lifestyle change were identified from both methods, and included time and financial constraints, childcare duties, lack of motivation, fatigue, and obstacles at work. Informants suggested facilitators for lifestyle change, including nutrition education, accountability, exercise partners/groups, access to gyms with childcare, and home exercise equipment. All focus group and informant interview participants reported access to the internet, and the majority expressed interest in an intervention program delivered primarily via the internet that would include the opportunity to work with a lifestyle coach.ConclusionTime constraints were a major barrier. Our findings suggest that an internet-based lifestyle intervention program should be tested as a novel approach to prevent type 2 diabetes in postpartum women with a history of GDM.Trial RegistrationClinicalTrials.gov: NCT01102530

Motivators and Barriers to a Healthy Postpartum Lifestyle in Women at Increased Cardiovascular and Metabolic Risk: A Focus-Group Study

Objective. To describe the motivators and barriers to the adoption of a healthy postpartum lifestyle after a pregnancy complicated by preeclampsia, intrauterine growth restriction, and/or gestational diabetes. Methods. Thirty-six women with complicated pregnancies participated in six focus-group interviews that aimed to explore the perceptions of modifiable determinants of postpartum lifestyle. Results. Although women expressed that they intended to live a healthy postpartum lifestyle, it was generally not achieved. The motivators included improving their own current health condition as well as modeling a healthy lifestyle for their children. Important barriers were reported to be lack of knowledge, poor recovery, and lack of professional support after delivery. Conclusions. The reported motivators and barriers can be used to develop a postpartum lifestyle intervention.

Effect of Postpartum Lifestyle Interventions on Weight Loss, Smoking Cessation, and Prevention of Smoking Relapse: A Systematic Review

Postpartum lifestyle interventions are recommended for women after pregnancies complicated by preeclampsia, intrauterine growth restriction, and/or gestational diabetes, since they are at increased cardiovascular risk. To identify potential intervention strategies to reduce this risk, a systematic review of the literature is presented on the effectiveness of postpartum lifestyle interventions aimed at weight loss, smoking cessation, and smoking relapse prevention. The main characteristics of these postpartum lifestyle interventions are briefly described. The PubMed, Embase, Web of Science, PsychInfo, and Cinahl databases were searched for studies on the effects of postpartum lifestyle interventions on weight loss, and smoking cessation or prevention of smoking relapse, initiated for up to 1 year postpartum. No studies on the effectiveness of postpartum lifestyle interventions after the aforementioned specific pregnancy complications were found. However, 21 studies are included that describe existing postpartum lifestyle interventions, which were applied to unselected (on the basis of pregnancy complications) postpartum women. Six of 8 weight loss interventions, 4 of 5 smoking cessation interventions, and 4 of 8 smoking relapse prevention interventions were effective. Individually tailored counseling, group counseling sessions, and use of diaries or other correspondence materials were shown to be effective. Currently, postpartum lifestyle interventions tailored specifically for women who experienced the pregnancy complications are lacking. While awaiting their development, it seems reasonable to utilize existing lifestyle interventions shown to be effective in unselected postpartum women. After completion of this educational activity, the obstetrician/gynecologist should be better able to: counsel patients on how to apply existing postpartum lifestyle intervention strategies aimed at weight loss, smoking cessation, and smoking relapse prevention to lower future cardiovascular risk; and educate postpartum women who have experienced preeclampsia, intra-uterine growth restriction, and/or gestational diabetes about their increased cardiovascular risk later in life. Obstetricians & Gynecologists, Family Physicians.

T14.2 Postpartum lifestyle intervention after complicated pregnancy proves feasible

To investigate hospitalizations up to 8 years after live birth among women who used assisted reproductive technology (ART) or who were subfertile compared with women who conceived naturally.Retrospective cohort.Deliveries among privately insured women aged ≥18 years between 2004 and 2017 from Massachusetts state vital records were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System and hospital observational/inpatient stays.We compared patients with ART, medically assisted reproduction (MAR), and unassisted subfertile (USF) delivery with those with fertile delivery.NA.Postdelivery hospitalization information was derived from the International Classification of Diseases codes for discharges and combined by type. The relative risks and 95% confidence intervals (CIs) of hospitalization for up to the first 8 years postdelivery were modeled.Among 492,515 deliveries, 5.6% used ART, 1.6% used MAR, and 1.8% were USF. Compared with fertile deliveries, deliveries that used ART or MAR or were USF were more likely to have hospital utilization (inpatient or observational stay) for any reason for up to 8 years of follow-up (USF, adjusted relative risk [aRR], 1.18 [95% CI, 1.12–1.25]; MAR, aRR, 1.20 [1.13–1.27]; and ART, aRR, 1.29 [1.25–1.34]). Assisted reproductive technology deliveries had an increased risk of hospitalization for conditions of the cardiovascular system (aRR, 1.31 [95% CI, 1.20–1.41]), overweight/obesity (aRR, 1.30 [1.17–1.44]), diabetes (aRR, 1.25 [1.05–1.49]), reproductive tract (aRR, 1.62 [1.47–1.79]), digestive tract (aRR, 1.39 [1.30–1.49]), thyroid (aRR, 2.02 [1.80–2.26]), respiratory system (aRR, 1.13 [1.03–1.24]), and cancer (aRR, 1.40 [1.18–1.65]) up to 8 years after delivery. Deliveries with MAR and subfertility had similar patterns of hospitalization as ART deliveries.Women who conceived through fertility treatment or experienced subfertility were at increased risk of subsequent hospitalization resulting from a variety of chronic and acute conditions.Hospitalizaciones hasta 8 años después del parto en mujeres subfértiles y tratadas con tecnología de reproducción asistida.Investigar las hospitalizaciones hasta 8 años después del nacimiento vivo entre mujeres que usaron tecnología de reproducción asistida (TRA) o que fueron subfértiles en comparación con mujeres que concibieron naturalmente.Cohorte retrospectiva.Los partos entre mujeres con seguro privado mayores de 18 años entre 2004 y 2017 de los registros vitales del estado de Massachusetts se vincularon con el Sistema de Información de Resultados Clínicos de la Sociedad de Tecnología de Reproducción Asistida y las estancias hospitalarias/observatorias.Comparamos pacientes con TRA, reproducción asistida médicamente (RAM) y parto subfértil no asistido (PSNA) con aquellos con parto fértil.NA.La información sobre la hospitalización posterior al parto se derivó de los códigos de la Clasificación Internacional de Enfermedades para las altas y se combinó por tipo. Se modelaron los riesgos relativos y los intervalos de confianza (IC) del 95% de la hospitalización hasta los primeros 8 años posteriores al parto.Entre 492.515 partos, el 5,6 % utilizó TRA, el 1,6 % utilizó RAM y el 1,8 % fue PSNA. En comparación con los partos fértiles, los partos que usaron TRA o RAM o PSNA tenían más probabilidades de tener una utilización hospitalaria (hospitalización o estancia de observación) por cualquier motivo durante un máximo de 8 años de seguimiento (PSNA, riesgo relativo ajustado [RRa], 1,18 [IC 95 %, 1,12–1,25]; RAM, RRa, 1,20 [1,13–1,27]; y TRA, RRa, 1,29 [1,25–1,34]). Los partos con tecnología de reproducción asistida tenían un mayor riesgo de hospitalización por afecciones del sistema cardiovascular. (RRa, 1,31 [IC 95 %, 1,20–1,41]), sobrepeso/obesidad (RRa, 1,30 [1,17– 0,44]), diabetes (RRa, 1,25 [1,05–1,49]), tracto reproductivo (RRa, 1,62 [1,47 –1,79]), tracto digestivo (RRa, 1,39 [1,30–1,49]), tiroides (RRa, 2,02 [1,80–2,26]), sistema respiratorio (RRa, 1,13 [1,03–1,24]) y cáncer (RRa, 1,40 [ 1.18–1.65]) hasta 8 años después del parto. Los partos con RAM y subfertilidad tuvieron patrones de hospitalización similares a los partos con TRA.Las mujeres que concibieron a través de un tratamiento de fertilidad o experimentaron subfertilidad tenían un mayor riesgo de hospitalización posterior como resultado de una variedad de condiciones crónicas y agudas.

T14.1 What effect can we expect of postpartum lifestyle intervention after preeclampsia?

Preeclampsia is a condition of pregnancy that is associated with high morbidity and mortality rates. Individuals diagnosed with preeclampsia have an increased chance of developing depression during pregnancy and in the postpartum period. This ultimately increases the risk for negative physical and emotional outcomes. A review of the etiology, pathophysiology, symptomatology, and risk factors for preeclampsia and depression, as well as the impact of COVID-19, can improve outcomes by helping nurses provide evidence-based holistic care. This article focuses on providing enhanced knowledge to help nurses identify the psychosocial aspects of preeclampsia and advocate for appropriate mental health assessment and intervention for affected individuals.