Page 173 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

3.5 Feasibility and effectiveness of a lifestyle intervention| 171
gestational diabetes mellitus. The proportions of eligible women that completed the intervention were 43%278 (intervention was initiated at seven to eight weeks postpartum with a follow-up of 12 months) and 24% respectively (women were recruited within one to three years after their pregnancy with a follow-up of two years)279. This might indicate that the window of opportunity for lifestyle intervention after a complicated pregnancy is most present shortly after delivery and disappears over time. Offering lifestyle intervention six weeks after delivery might lead to a higher proportion of women complying to lifestyle intervention.
Of all eligible women in the intervention group, 21% could not be traced. Other postpartum lifestyle studies report similar percentages up to 35%279. Traceability might be improved shortly after delivery, when women are still in contact with their gynaecologist or midwife.
We used a health education program with tailored advice, already on-line available by the Dutch Heart Foundation. The women in our study liked the possibility to complete the computer-tailored health education online in their own time and found its advice easy to understand. It was, however, not specifically tailored to postpartum women and therefore the advice was not always readily applicable. During the counselling sessions, we tailored the advice to the personal situation. New developments like web-based tailored advice for postpartum women278 as well as the use of new media like smartphones280 281 are promising new ways to challenge low participation and adherence in postpartum lifestyle interventions.
Tailoring the start of the intervention to the woman’s need might increase participation and adherence rates. Some women who completed the study would in retrospect have preferred to start with the intervention several weeks postpartum. In our study, women were informed at a fixed moment (five months postpartum).