Cardiovascular Risk Reduction in Women Following Hypertensive Disorders of Pregnancy – a Prospective, Randomised, Controlled Interventional StudyKardiovaskuläre Risikoreduktion bei Frauen mit Zustand nach hypertensiven Schwangerschaftserkrankungen – eine prospektive, randomisierte, kontrollierte Interventionsstudie

3 years ago

Cardiovascular Risk Reduction in Women Following Hypertensive Disorders of Pregnancy – a Prospective, Randomised, Controlled Interventional StudyKardiovaskuläre Risikoreduktion bei Frauen mit Zustand nach hypertensiven Schwangerschaftserkrankungen – eine prospektive, randomisierte, kontrollierte Interventionsstudie

Marcus Riemer, Stephan Schulze, Lisa Wagner, Manon Richter, Gertrud Ayerle, Andreas Simm, Sven Seeger, René Schwesig, Michael Tchirikov, Gregor Seliger

Background Women have a markedly increased lifetime risk for cardiovascular morbidity and mortality following hypertensive disorders of pregnancy. Arterial stiffness is regarded as a target parameter for reducing cardiovascular risk and can be modified by lifestyle changes. Methods In a prospective, randomised, controlled interventional study, starting 6 weeks postpartum, the effect of nutritional intervention combined with an intensive 6-month cardiovascular exercise programme on arterial stiffness was investigated by means of pulse wave velocity (PWV) in 38 women with severe hypertensive disorder of pregnancy (preeclampsia with or without pre-existing hypertension and/or HELLP syndrome). A reference group was formed with postpartum women without pregnancy complications or known cardiovascular risk and the arterial stiffness was studied by means of PWV at the time of delivery. The PWV was measured in the intervention and control groups within a week after delivery and after 32 weeks (6 weeks + 6 months). A feasibility analysis was performed in addition. Results 29 of 38 women with severe hypertensive disorder of pregnancy and 38 postpartum women in the reference group were included in the analysis (intervention group n = 14; control group n = 15; reference group n = 38). Adherence to a) the nutritional counselling and b) the intensive cardiovascular exercise programme was 73% and 79% respectively. A clinically significant difference (d = 0.65) in pulse wave velocity between the intervention and control groups was found after 6 months (6.36 ± 0.76 vs. 7.33 ± 2.25 m/s; group × time: p = 0.632). The PWV of the intervention group corresponded to that of the reference group at the end of the study (6.36 ± 0.76 m/s vs. 6.5 ± 0.70; d = 0.19), while the results in the control group differed markedly from this (7.33 ± 2.25 m/s; d = 0.56). Conclusion The study documents the feasibility of lifestyle intervention with physical exercise after delivery (starting 6 weeks postpartum). The intervention showed a significant clinical effect by reducing arterial stiffness to the level of the reference group. Before this intervention can be included in the standard of care and prevention, follow-up studies must confirm these results and the medium-term effects on cardiovascular risk. Received: 06 July 2020

Accepted after revision: 31 December 2020

Publication Date:
09 August 2021 (online) © 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Georg Thieme Verlag KG
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Publisher URL: http://dx.doi.org/10.1055/a-1345-8733

DOI: 10.1055/a-1345-8733