Page 192 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

190 | Part 4 Discussion
This might be a power-problem, since pre-pregnancy lifestyle interventions are scarce. It might be hypothesized that lifestyle intervention might be more effective if offered for a longer period, starting shortly after complicated pregnancy.
Another interesting secondary outcome would be psychological well- being during lifestyle intervention. Psychological burden might be an undervalued but important independent risk factor for cardiometabolic disease in women52, and might offer a new terrain of prevention of cardiometabolic disease in women’s health.
Clinical implications and current guidelines
Current guidelines differ in their advice what to do after a complicated pregnancy like preeclampsia (table 4.1). The newest guidelines recommend counselling of women that they will benefit from a healthy lifestyle. The somewhat older NICE guideline288 does not mention lifestyle intervention, but advises to inform women about their increased risk of future disease. However, guidelines do not guide in the organization of lifestyle interventions.
Caution must be taken to advise for routine extensive cardiometabolic screening without proper studies on best practice. Benefits might be low, since risk profiles might be too low to start treatment. Although positive effects of lifestyle intervention could be observed, they might be small and therefore might have discouraging effects on compliance. Also the absence of classical risk factors for future disease could falsely reassure women that they already have a healthy lifestyle, leaving a risk for drop out of lifestyle coaching.