Postpartum Interventions to Reduce Long-Term Cardiovascular Disease Risk in Women After Hypertensive Disorders of Pregnancy: A Systematic Review

摘要

Introduction Hypertensive disorders (HDP) affect approximately 7% of pregnancies. Epidemiological evidence strongly suggests HDP independently increases that individual’s risk of later cardiovascular disease (CVD). Focus on reduction or mitigation of this risk has been limited. This review seeks to identify trialled interventions to reduce cardiovascular risk after HDP. Methods Online medical databases were searched to identify full-text published results of randomised controlled trials (RCT) in women 10 years postpartum after HDP that trialled interventions to reduce cardiovascular risk. Outcomes sought included cardiovascular disease events, chronic hypertension, and other measures of cardiovascular risk such as obesity, smoking status, diet, and physical activity. Publications from January 2008-July 2019 were included. Results Two RCTs were identified. One, a trial of calcium versus placebo in 201 women with calcium commenced from the first follow-up visit outside of pregnancy and continued until 20 weeks’ gestation if another pregnancy occurred. A non-significant trend towards decreased blood pressure was noted. The second RCT of 151 women tested an online education programme (versus general information to control group) to increase awareness of risk factors and personalised phone-based lifestyle coaching in women who had a preeclampsia affected pregnancy in the 5 years preceding enrolment. Significant findings included increase in knowledge of CVD risk factors, reported healthy eating and decreased physical inactivity, however adoption of a promoted heart healthy diet and physical activity levels did not differ significantly between groups. Several observational studies after HDP, and one meta-analysis of studies of lifestyle interventions not performed specifically after HDP but used to extrapolate likely benefits of lifestyle interventions, were identified which supported the use of lifestyle interventions. Several ongoing RCTs were also noted. Discussion There is a paucity of intervention trials in the early years after HDP to guide evidence-based cardiovascular risk reduction in affected women. Limited evidence suggests lifestyle intervention may be effective, however degree of any risk reduction remains uncertain. Conclusion Sufficiently powered randomised controlled trials of appropriate interventions (e.g. lifestyle behaviour change, pharmacological) are required to assess the best method of reducing the risk of cardiovascular disease in this at-risk population of women.