Page 159 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

3.5 Feasibility and effectiveness of a lifestyle intervention| 157
restriction was defined according to ACOG-criteria269: fetal abdominal circumference < 5th percentile and umbilical artery Doppler with a pulsatility index ≥ 95th percentile and/or absent or reversed end-diastolic flow on last ultrasonic examination before delivery. Gestational diabetes mellitus was defined according to the 2003 report of the international expert committee of the American Diabetes Association on the diagnosis and classification of diabetes mellitus243: a fasting glucose > 6.1 mmol/L or a 2-hour glucose > 7.8 mmol/L after a 75-grams oral glucose tolerance test. Other inclusion criteria were age ≥ 18 years at time of inclusion, Dutch, Turkish or Moroccan ethnicity and mastery of the Dutch language. Women with pre-pregnancy cardiovascular and/or metabolic conditions, like renal insufficiency, pre-existent hypertension or diabetes mellitus were excluded. Cases of fetal growth restriction due to intra- uterine infection, congenital anomalies or abnormal fetal karyotype were also excluded.
At the Erasmus University Medical Center in Rotterdam (tertiary care hospital) and three secondary care hospitals (Sint Franciscus Hospital, Rotterdam, Maasstad Hospital, Rotterdam and Sint Elisabeth Hospital, Tilburg) women were screened for eligibility and asked to participate in the lifestyle intervention program. At the Amphia Hospital, Breda (secondary care hospital) women were screened for eligibility and subsequently served as the control group. At 5 months postpartum all eligible women were given or sent information about the study together with a letter of invitation to participate. If no response was received within two weeks, women were called on different weekdays. If twice unanswered, women were registered as unable-to-contact. Interested women were invited for a first visit six months postpartum. If during this visit informed consent was obtained, they were registered as participants.