Page 176 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

174 | Part 3 Lifestyle intervention
applicable to other than Dutch women, is unclear. Third, a major part of the women had received tertiary care. Whether our results are applicable to all women with complicated pregnancies, is unclear.
The criteria we used for gestational diabetes mellitus were based on the 2003 report of the expert committee on the diagnosis and classification of diabetes mellitus243. In 2010 new criteria for gestational diabetes mellitus were presented after completion of the HAPO-study286. Compared to the inclusion criteria of our study, the fasting glucose threshold is lower (5.1 mmol/l) and the 2-h glucose threshold after a 75-grams oral glucose tolerance test is higher (8.4 mmol/l). This might limit generalizability of our results to women who have been diagnosed with gestational diabetes mellitus based on other criteria than the ones we used.
Meaning of the study: possible explanations and implications for clinicians and policymakers
This study supports the feasibility and effectiveness of a lifestyle intervention after complicated pregnancies. We suggest that clinicians should discuss the possible beneficial effects of lifestyle intervention with women who experienced a cardiometabolic complicated pregnancy at the regular visit 6 weeks postpartum. If women are willing to comply, lifestyle intervention programs should be made available, preferably close to home in a primary health care setting.
Current guidelines recommend lifestyle modification and early evaluation for the most high-risk women287, the provision of information to patients and primary care clinicians about increased risks in later life288, assessment of traditional risk factors and to pursue a healthy lifestyle289, counselling about beneficial effects of a healthy lifestyle and regular (1-5 yearly) cardiovascular