After hypertensive pregnancy, women have a doubled risk of cardiovascular disease and death within 20 years. Some success of lifestyle intervention after diabetic pregnancy in reducing maternal risks is reported; no Australian data exists after hypertensive pregnancy. This study will provide much needed evidence of whether one-off assessment and education, or education plus lifestyle intervention, is superior to current usual care after hypertensive pregnancy. If evidence of benefit is found, the postpartum clinic and Get Healthy intervention is readily translatable into practice change throughout NSW health services.
Research Question (s):
1. Does an individualised six month healthy lifestyle program instituted six months after hypertensive pregnancy result in lifestyle behaviour and/or blood pressure (BP) change compared to (a) routine care, or (b) one-off individualised risk assessment and education?
2. Secondarily, do such interventions demonstrate likely cost-effectiveness and patient acceptability?
The project is a three-arm randomised controlled trial of women after hypertensive pregnancy, with women recruited after giving birth at one of the study hospitals. Women (n=480) will be randomised into one of then following groups:
1. Usual postpartum care as per hospital guidelines and at discretion of the treating team;
2. Attendance at follow-up clinic six months postpartum, assessment of personal cardiovascular risk profile then one-off cardiovascular diet and exercise education; or
3. In addition to 2., ongoing diet and exercise coaching for six months through the NSW Health Get Healthy Service Women will then be assessed 12 months post-partum [after the active intervention in 3. concludes].
Primary outcomes:
1. Maternal lifestyle behaviour change as assessed by change in weight and/or waist circumference
2. Mean systolic blood pressure.
Secondary outcomes including additional lifestyle behaviour change markers physical activity; fruit and vegetable intake levels; other clinical measures including vascular function, mean arterial pressure, cholesterol, glucose and cardiovascular risk score; economic analysis; patient satisfaction.
Collaborators: NSW Office of Preventive Health, NSW Ministry of Health (Maternity, Child, Youth and Paediatrics Unit, Health and Social Policy Bbranch), Australian Action on Preeclampsia (AAPEC) – peak, Australian consumer organisation for women affected by hypertensive pregnancy, Sydney Local Health District, National Heart Foundation Australia (NSW Division)