Impact of pregnancy on long‐term health: Advances in postpregnancy care—An opportunity to improve long‐term maternal health

McAuliffe, Fionnuala M.

doi:10.1002/ijgo.14536

Cited by 5 publications

(8 citation statements)

References 32 publications

(52 reference statements)

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“…This innovative tool facilitates screening and planning for the optimal management of women who have experienced complications during pregnancy 4 . The goal is to provide advice and targeted interventions during the postpartum period to reduce the risk of future health events, with the aim of global use 4 …”

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confidence: 99%

“…The FIGO Committee on Impact of Pregnancy on Long‐term Health believes that an innovative pregnancy passport would be the most convenient, pragmatic, and effective tool for postpartum care to achieve this goal 4 . While some centers have developed pregnancy passports, they are not widely used and are mainly limited to high‐income countries 4 . Therefore, FIGO has adapted a user‐friendly pregnancy passport that recommends minimal and optimal management strategies for use in different healthcare settings; it can easily be adopted and utilized globally 3 .…”

Section: Figurementioning

confidence: 99%

“…This innovative tool facilitates screening and planning for the optimal management of women who have experienced complications during pregnancy. 4 The goal is to provide advice and targeted interventions during the postpartum period to reduce the risk of future health events, with the aim of global use. 4 A significant body of evidence has demonstrated that women who have had HDP are four times as likely to develop chronic hypertension, three times as likely to meet the for metabolic syndrome, and twice as likely to experience long-term cardiovascular disease (CVD)-including coronary artery disease, heart failure, peripheral vascular disease, and stroke-and CVD-related mortality.…”

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confidence: 99%

“…4 The goal is to provide advice and targeted interventions during the postpartum period to reduce the risk of future health events, with the aim of global use. 4 A significant body of evidence has demonstrated that women who have had HDP are four times as likely to develop chronic hypertension, three times as likely to meet the for metabolic syndrome, and twice as likely to experience long-term cardiovascular disease (CVD)-including coronary artery disease, heart failure, peripheral vascular disease, and stroke-and CVD-related mortality. 2,5 In addition, women with a history of HDP are at a twofold increased risk of chronic kidney disease and end-stage kidney disease, as well as a two-to threefold increased risk of type 2 diabetes mellitus (T2DM) later in life.…”

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confidence: 99%

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FIGO pregnancy passport: A useful tool for women and their healthcare providers on health risks following pregnancy complications

Nguyen-Hoang

Smith

Bergman

et al. 2023

Intl J Gynecology & Obste

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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FIGO pregnancy passport: A useful tool for women and their healthcare providers on health risks following pregnancy complications

Nguyen-Hoang

Smith

Bergman

et al. 2023

Intl J Gynecology & Obste

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“…The potential for pregnancy care to be part of an integrated approach to NCD prevention has been recommended by the International Federation of Gynaecology and Obstetrics (FIGO) (10) and other leaders in women's health. (11)(12)(13)) Anaemia, HDP and GDM have been identi ed as priority areas to improve maternal and newborn outcomes in rural India.…”

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confidence: 99%

A community-based intervention to improve screening, referral, and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial

Hirst

Votruba

Billot

et al. 2023

Preprint

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Background Medical complications during pregnancy, including anaemia, gestational diabetes mellitus and hypertensive disorders of pregnancy place women are at higher risk of long-term complications. Scalable and low-cost strategies to integrate non-communicable disease screening into pregnancy care are needed. We aim to determine the effectiveness and implementation components of a community-based, digitally-enabled approach, “SMARThealth Pregnancy”, to improve health during pregnancy and the first year after birth. Methods A pragmatic, parallel-group, cluster-randomised, type 2 hybrid effectiveness-implementation trial of a community-based, complex intervention in rural India to decrease anaemia (primary outcome, defined as haemoglobin < 12g/dL) and increase testing for haemoglobin, glucose and blood pressure (secondary outcomes) in the first year after birth. Primary Health Centres (PHCs) are the unit of randomisation. PHCs are eligible with: (1) >1 medical officer and >2 community health workers; and (2) capability to administer intravenous iron sucrose. Thirty PHCs in Telangana and Haryana, will be randomised 1:1 using a matched-pair design accounting for cluster size and distance from the regional centre. The intervention comprises: (i) an education programme for community health workers and PHC doctors; (ii) the SMARThealth Pregnancy App for health workers to support community-based screening, referral, and follow-up of high-risk cases; (iii) a dashboard for PHC doctors to monitor high-risk women in the community; (iv) supply chain monitoring for consumables and medications, and (v) stakeholder engagement to co-develop implementation and sustainability pathways. The comparator is usual care with additional health worker education. Secondary outcomes include implementation outcomes assessed by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), clinical endpoints (anaemia, diabetes, hypertension), clinical service delivery indicators (quality of care score), mental health, and lactation practice (PHQ9, GAD7, EuroQoL-5D, WHO IYCF questionnaire). Discussion Engaging women with screening after a high-risk pregnancy is a challenge and has been highlighted as a missed opportunity for the prevention of non-communicable diseases. The SMARThealth Pregnancy trial is powered for the primary outcome and will address gaps in the evidence around how pregnancy can be used as an opportunity to improve women’s lifelong health. If successful, this approach could improve the health of women living in resource-limited settings around the world. Trial registration: clinicaltrials.gov NCT05752955. Date of registration 3 March 2023

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Diet quality and blood pressure among pregnant women with overweight or obesity: A secondary analysis of two randomized controlled trials

Lynch,

Killeen,

O'Brien

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionMaternal obesity is a significant risk factor for hypertensive disorders of pregnancy. High diet quality may protect against this, yet data regarding the relationship between diet quality and blood pressure among pregnant women with raised body mass index (BMI) is limited.Material and methodsThis is a secondary analysis (n = 543) of women with BMI ≥25 kg/m2 from two randomized controlled trials; PEARS (Pregnancy Exercise and nutrition Research Study with smartphone application support) and ROLO (Randomized cOntrol trial of LOw glycemic index diet to prevent macrosomia in euglycemic women). Blood pressure was measured at 10–18 weeks and 28 weeks of pregnancy. Mean arterial pressure was calculated as (diastolic blood pressure [systolic blood pressure diastolic blood pressure]). Diet quality was assessed using 3‐day food diaries, and Alternative Healthy Eating Index for Pregnancy (AHEI‐P) scores were generated, quantifying alignment of food intakes with dietary guidelines in first and early third trimesters. The cohort was divided based on AHEI‐P tertiles to explore differences at an alpha significance value of <0.05.ResultsThe mean age of the group was 32.21 ± 4.39 years with a median body mass index (BMI) of 28.13 (IQR 3.47) kg/m2. Mean arterial pressures in the first and third trimesters were 81.07 ± 9.00 mmHg and 82.33 ± 7.53 mmHg, respectively. Rates of elevated blood pressure (≥120/80 mmHg) were 22.33% in trimester 1 and 24.48% in early trimester 3. Mean AHEI‐P scores in trimester 1 and early trimester 3 were 53.90 ± 10.43 and 54.05 ± 10.76, respectively. There was no correlation between AHEI‐P score and blood pressure and no differences in blood pressure between AHEI‐P tertiles at either timepoint (all P‐values <0.05). A higher proportion of those with elevated early third trimester blood pressure had a BMI of ≥30 kg/m2 compared with those with normal blood pressure (40.31% vs 28.64%, P = 0.016).ConclusionsWhile diet remains an important factor in maternal health and wellbeing, we did not find a relationship between diet quality as measured by AHEI‐P and blood pressure among pregnant women with BMI ≥25 kg/m2. High BMI remains a risk factor for hypertensive disorders of pregnancy.

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Impact of pregnancy on long‐term health: Advances in postpregnancy care—An opportunity to improve long‐term maternal health

Abstract: Synopsis Pregnancy presents a unique opportunity in the life course to improve women's long‐term health. Postpregnancy interventions, breastfeeding, and optimal nutrition prevent the development of chronic diseases.

Cited by 5 publications

References 32 publications

FIGO pregnancy passport: A useful tool for women and their healthcare providers on health risks following pregnancy complications

FIGO pregnancy passport: A useful tool for women and their healthcare providers on health risks following pregnancy complications

A community-based intervention to improve screening, referral, and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial

Diet quality and blood pressure among pregnant women with overweight or obesity: A secondary analysis of two randomized controlled trials

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