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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(08): 966-978
DOI: 10.1055/a-1345-8733
GebFra Science
Original Article/Originalarbeit

Cardiovascular Risk Reduction in Women Following Hypertensive Disorders of Pregnancy – a Prospective, Randomised, Controlled Interventional Study

Artikel in mehreren Sprachen: English | deutsch
Marcus Riemer
1   Universitätsklinik und Poliklinik für Geburtshilfe und Pränatalmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
2   Klinik für Geburtshilfe, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
,
Stephan Schulze
3   Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
,
Lisa Wagner
1   Universitätsklinik und Poliklinik für Geburtshilfe und Pränatalmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
,
Manon Richter
4   Institut für Leistungsdiagnostik und Gesundheitsförderung, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
,
Gertrud Ayerle
5   Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
,
Andreas Simm
6   Universitätsklinik für Herz- und Thoraxchirurgie Halle, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
,
Sven Seeger
2   Klinik für Geburtshilfe, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
,
René Schwesig
3   Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
,
Michael Tchirikov
1   Universitätsklinik und Poliklinik für Geburtshilfe und Pränatalmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
,
Gregor Seliger
1   Universitätsklinik und Poliklinik für Geburtshilfe und Pränatalmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Abstract

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.

Key words

preeclampsia - HELLP syndrome - arterial stiffness - pulse wave velocity - cardiovascular risk


Publikationsverlauf

Eingereicht: 06. Juli 2020

Angenommen nach Revision: 31. Dezember 2020

Artikel online veröffentlicht:
09. August 2021

© 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
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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