Page 65 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

INTRODUCTION
Women who have experienced preeclampsia, intrauterine growth restriction, and/or gestational diabetes are at increased risk to develop cardiovascular disease later in life compared with women who did not experience these complications1-3 10. Women with such complications more often exhibit cardiovascular risk factors, including higher circulating concentrations of fasting insulin, increased blood pressure, increased lipids, increased body mass index, and increased insulin resistance21 24 26 31 142-144. It has been suggested that women who have experienced these complications during pregnancy should be screened for postpartum cardiovascular risk factors, and should be offered a postpartum lifestyle intervention to reduce future cardiovascular morbidity and mortality24 142. Moreover, after a pregnancy complicated by preeclampsia, intrauterine growth restriction, and/or gestational diabetes, the immediate postpartum period is considered to be a window of opportunity for preventive interventions1. Lifestyle interventions have been effective in ameliorating risk factors for cardiovascular disease, by promoting smoking cessation and weight loss145 146, with substantial effects on cardiovascular risk reduction147.
To date, however, few data are available to inform the choice of specific lifestyle interventions for promoting a healthy postpartum lifestyle after complicated pregnancy. Considering the specific challenges that women who have experienced complications face, such lifestyle interventions would ideally be tailored to the specific needs, characteristics, and preferences of these high- risk women in order to promote participation and adherence to the intervention. For example, compared with women with an uncomplicated pregnancy, women who experienced pregnancy complications more frequently experience
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