Page 157 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

3.5 Feasibility and effectiveness of a lifestyle intervention| 155
INTRODUCTION
After pregnancies complicated by preeclampsia, fetal growth restriction and/or gestational diabetes mellitus, women are at an increased risk to develop cardiometabolic disease in later life. Women with a history of preeclampsia suffer from a two-fold increased risk of ischemic heart disease and stroke80. This increased risk may be due to shared risk factors, or an independent association between preeclampsia and cardiometabolic disease in later life1. Women with fetal growth restriction have an up to three-fold increased risk of future cardiovascular disease if it was the only pregnancy complication and an up to seven-fold increased risk in combination with preeclampsia3 11 14 16. Women with a history of gestational diabetes mellitus have a 20-60% risk of developing diabetes mellitus 5 to 10 years later266.
Based on these observations pregnancy could be interpreted as a stress- test for cardiometabolic health1. As stress-test, pregnancy could identify young women with a high risk of future cardiovascular disease. So far, the scientific focus has been to examine differences in cardiometabolic risk factors between women with a history of complicated pregnancies and those with uncomplicated pregnancies17.
As a stress-test for cardiometabolic health, a complicated pregnancy could identify ‘high-risk’ women at a young age. This provides opportunities to prevent future cardiometabolic disease. In addition, the complicated pregnancy might boost a woman’s motivation to prevent future disease, thus providing a window of opportunity for starting a lifestyle intervention program4.
Focus group studies have confirmed that women are willing to participate in a lifestyle intervention after pregnancy complications186 206 267. However, lifestyle interventions after pregnancies complicated by preeclampsia or fetal