title: OS109. Lifestyle intervention after complicated pregnancy successfully improves saturated fat-intake, but not exercise and smoking habits: results of the pro-active study.
abstract: BACKGROUND
  Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and/or gestational diabetes are at increased risk of future cardiovascular and metabolic disease. Lifestyle intervention may help these women to effectively lower these risks.
  
  
  OBJECTIVE
  To test if offering lifestyle intervention after a complicated pregnancy significantly improves saturated fat-intake and exercise (primary objectives) and/or smoking habits (secondary objective).
  
  
  METHODS
  The Pro-Active study (Postpartum Rotterdam Appraisal of Cardiovascular health and Tailored Intervention) is a feasibility study to develop and evaluate a postpartum lifestyle intervention program. In a prospective case-control setting we tested the effect of the lifestyle intervention. Women were included between April 2007 and August 2009. They were eligible if ⩾18 years old at time of inclusion, being able to understand and speak the Dutch language and not having pre-existing conditions that could interfere with the lifestyle intervention. Cases were offered lifestyle intervention by a trained counsellor between 6 and 10 months postpartum. During 3 private sessions, mainly exercise and fat-intake and to some extend smoking habits were discussed and aims were made to improve lifestyle. Controls did not receive these sessions, but were not restricted to improve lifestyle on their own. Lifestyle habits were scored at 6 and 13 months postpartum. For saturated fat-intake we used the Maastricht Fatlist. For exercise we used the International Physical Activity Questionnaire (IPAQ). For smoking habits we used a short version of the questionnaire of STIVORO (the Dutch anti-smoking association). We also performed a formative evaluation of the intervention program.
  
  
  RESULTS
  During our study 1121 women gave birth after a complicated pregnancy. 490 Women were eligible for the study of which 240 women (49%) gave informed consent to participate. 56 Women (23%) were lost-to-follow-up, leaving 186 women for the analysis. Between 6 and 13 months postpartum saturated fat-intake was significantly reduced by 3.6g/day (95%>CI 1.8-5.4) in cases compared to controls. Exercise was improved in cases compared to controls, but it did not reach significance (277 MET's (-2699-3254)). Although smoking decreased from 14.5% to 10.4% in cases, it was not significant and comparable to the decrease in controls (15.0% to 8.4%). The formative evaluation showed that the most important motivator to improve lifestyle was the increased risk of future cardiovascular and metabolic disease (70%) and the increased risk for recurrence in a next pregnancy (57%). Main barriers were an already busy life (40%), distance (35%) and duration (38%) of travelling to the hospital and to early postpartum to pay attention to lifestyle (26%).
  
  
  CONCLUSIONS
  Lifestyle intervention after complicated pregnancy may be effective in improving saturated fat-intake. Other interventions, specially aimed at postpartum women, are needed to improve exercise and smoking habits. More research is needed to develop lifestyle intervention program specifically aimed at these women. New possibilities of multimedia are promising.
authors.affiliation: Obstetrics & Gynecology, Rotterdam, Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Berks
authors.affiliation: Public Health, Erasmus MC, Rotterdam, Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hoedjes
authors.affiliation: Public Health, Erasmus MC, Rotterdam, Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Raat
authors.affiliation: Obstetrics & Gynecology, UMCU, Utrecht, Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Franx
authors.affiliation: Obstetrics & Gynecology, Rotterdam, Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Duvekot
authors.affiliation: Obstetrics & Gynecology, Rotterdam, Netherlands.
authors.forename: E A
authors.initials: EA
authors.lastname: Steegers