Page 189 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

admission or death of their newborn293-295. Other determinants were a younger age, severity of preeclampsia, cesarean section and low gestation age293.
When they need to go back to work at 10-12 weeks after delivery, they generally do not feel fully recovered. We started our intervention program at 6 months postpartum. Some women expressed their wish to participate, but had lack of time. Tailoring the moment to start with lifestyle intervention after complicated pregnancy can improve participation rates.
Gynecologists, midwifes and primary health care physicians should identify women at risk of future cardiometabolic disease at 6 weeks postpartum and inform them about their risk profile and risk of future cardiometabolic disease. They should initiate a lifestyle intervention program in combination with psychological counselling. The latter especially for those who have risk factors for post-traumatic stress, like younger maternal age and previous severe preeclampsia, cesarean section, fetal death, extreme prematurity and NICU- admission.
A strong recommendation based on this thesis is that gynecologists and midwifes should be responsible for the identification of these ‘high risk’ women and that primary health care physicians should be responsible for initiating a lifestyle intervention program and psychological counselling. The physician should refer to a trained lifestyle coach/counsellor, who has the time to listen and could help the women to set and reach their lifestyle goals. The coach/counsellor should guide these women at least 5 to 10 years, but probably lifelong.
However, more knowledge is still needed on the effects of lifestyle intervention after complicated pregnancy. Future research should include (1) randomization between different intervention strategies and (2) long-term maternal cardiometabolic follow- up.
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