Page 174 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

172 | Part 3 Lifestyle intervention
We used the proportion of eligible women who complied with the intervention as measure of feasibility. Other studies focus on dropout rate60. However, dropout rate is biased by the motivation of participants and thus by the process of inclusion. By comparing studies by the proportion of eligible women who complied with the intervention, this bias is eliminated.
Effectiveness
Women in the intervention group had a significant weight loss that could be attributed to the lifestyle intervention. Also, the secondary outcomes BMI, waste-to-hip ratio, HOMA2-score and total fat score significantly improved.
Blood pressure medication was significantly more prescribed in the intervention group than in the control group. An explanation might be that the intervention group more often had preeclampsia and severe preeclampsia, leading to a longer recovery time and a longer need for blood pressure medication up to two years202. This was also expressed in a significantly higher baseline blood pressure in the intervention group. However, after adjustment for these variables the difference remained significant.
The effect of improved cardiometabolic risk factors was achieved between 6 and 10 months. Between 10 and 13 months a loss of effect was observed. Similar rebound effects were observed in other lifestyle intervention studies154. There are currently no strategies that effectively address the challenge of promoting sustained long-term behavioural change282. Studies with longer follow-up and on-going counselling with promising new strategies280 281 must show if and how the improved cardiometabolic risk status by postpartum lifestyle intervention can be sustained.
The potential reduction in risk of recurrence of the sustained pregnancy complication was an important motivator for the women participating in the