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
