Page 198 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

196 | Part 5 Summary
preeclampsia exhibits a direct effect on postpartum cardiovascular health. In chapter 2.2 we used a retrospective cohort to test the hypothesis that different phenotypes of preeclampsia are associated with thrombophilia factors. We also provide an overview of the literature. We conclude that only anti-phospholipid antibodies are associated with (severe) preeclampsia.
The development and evaluation of a lifestyle intervention program after cardiometabolic complicated pregnancy is described in part 3. In Chapter 3.1 we provide a review of the literature (until May 2010) to identify potential intervention strategies. We found no studies on postpartum lifestyle interventions after cardiometabolic complicated pregnancies. We included 21 studies on postpartum lifestyle intervention on unselected women on the basis of pregnancy complications. Six of 8 weight loss interventions, 4 of 5 smoking cessation interventions, and 4 of 8 smoking relapse prevention interventions were shown to be effective. In chapter 3.2 we estimate the effects of lifestyle intervention after preeclampsia on the risk of cardiovascular disease. First, the differences in cardiovascular risk factors after preeclampsia compared to an uncomplicated pregnancy were estimated. Second, the effects of lifestyle interventions on cardiovascular risk factors were estimated. Validated risk prediction models were used to translate these results into an effect on cardiovascular risk. We estimated the odds-ratio of cardiovascular disease after lifestyle interventions on a combination of exercise, dietary habits and smoking cessation to be 0.91 (0.87-0.96). Since lifestyle intervention in this model does not completely ameliorate the risk of cardiovascular disease, we also conclude that preeclampsia may represent an independent risk factor for cardiovascular disease.
In chapter 3.3 and chapter 3.4 we describe our focus group studies on women after complicated pregnancies. With regard to women’s preferences for