Online intervention improved knowledge of cardiovascular risks, confidence in achieving diet goals, and reduction in physical inactivity
Boston, MA — For many pregnant women, a diagnosis of preeclampsia can come as a shock. While more common among women carrying multiples and those with chronic high blood pressure, the condition can occur in healthy women without any symptoms. Preeclampsia resolves after a mother gives birth, but women who have had preeclampsia during pregnancy are at heightened risk for cardiovascular diseases later in life. Researchers estimate that women with prior preeclampsia have four times the risk of developing chronic hypertension, and have double the risk for coronary heart disease, stroke and venous thromboembolic events in the decades after pregnancy. Investigators at Brigham and Women's Hospital have worked closely with patients to develop an online intervention program aimed at women who have recently had preeclampsia to give them the tools needed to help reduce risk of cardiovascular disease. The team, co-led by Ellen W. Seely, MD, and Janet Rich-Edwards, ScD, MPH, conducted a randomized controlled trial of the internet-based lifestyle intervention, known as Heart Health 4 Moms (HH4M). After nine months, participants in the intervention group reported significantly greater knowledge of cardiovascular disease risk factors, increased self-confidence in their ability to stick to a healthy diet and less physical inactivity than in the control group. The team's results are published in the Journal of Women's Health.
"For many women, preeclampsia is a wake-up call," said Seely, senior author of the study and the director of Clinical Research for the Brigham's Endocrinology, Diabetes and Hypertension Division. "This is a medical complication that goes away when a woman gives birth, but what remains is an increased risk of cardiovascular disease later in life. We think there's an opportunity to decrease that risk by intervening and offering women the kinds of tools and support that are most useful to them for where they are in life."
Preeclampsia affects 4 to 8 percent of American mothers. At every prenatal appointment, health care providers check a woman's blood pressure and urine protein levels for signs of preeclampsia. Preeclampsia can cause high blood pressure, protein in the urine, and water retention. If left untreated, preeclampsia can lead to serious, and even deadly, complications for the mother and baby.
"Many women — and even physicians — don't realize that preeclampsia is associated with cardiovascular disease after pregnancy," said Seely. "Education is a big component of our intervention; you can't prevent something if you don't know you're at risk for it."
To design an intervention that would meet the needs of new mothers who had recently had preeclampsia, the Brigham research team began by conducting focus groups with patients. Based on that feedback, they designed online educational modules, created a community forum, and offered communication with a lifestyle coach. The study's 151 participants were randomized to participate in either this active intervention or in a control intervention, which provided them with static educational resources about cardiovascular risks associated with preeclampsia and lifestyle recommendations to prevent them. The primary outcomes for the study were changes in physical in/activity; adherence to the Dietary Approaches to Stop Hypertension (DASH) diet; knowledge of and personal control over cardiovascular risk; and self-efficacy, or confidence in one's ability to make behavioral changes, in eating a healthy diet and increasing physical activity.
The retention and participation rates for both arms of the study were high (both were greater than 90 percent), especially compared to more traditional face-to-face interventions. In the active intervention arm, 84 percent of participants accessed at least one online educational module and 89 percent completed at least three scheduled calls with the coach. The team found significant improvement in cardiovascular disease risk knowledge, self-efficacy to achieve a healthy diet, and reduction in physical inactivity among the women who received the active intervention. The groups did not differ in the sense of personal control of cardiovascular disease risk factors, adherence to the DASH diet, self-efficacy for physical activity, or reported physical activity.
"Patients said that they were motivated to improve their diet during pregnancy and wanted to continue a healthy lifestyle after pregnancy," said Rich-Edwards, first author of the paper and the director of Developmental Epidemiology at the Connors Center for Women's Health and Gender Biology at the Brigham. "Many women experience preeclampsia as their first major health event. They may be thinking about their health and the health of their family and may be motivated to create healthier eating and activity habits. This means that there may be a unique window of opportunity to intervene and help them decrease their risk of cardiovascular disease."
Funding for this project was provided by the Patient Centered Outcomes Research Institute Contract CER-1306-02603. Co-authors include Jennifer J. Stuart, Geraldine Skurnik, Andrea T. Roche, Eleni Tsigas, Garrett M. Fitzmaurice, Louise E. Wilkins-Haug and Sue E. Levkoff.
