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Roth H, Homer CSE, Arnott C, Roberts L, Brown M, Henry A. Assessing knowledge of healthcare providers concerning cardiovascular risk after hypertensive disorders of pregnancy: an Australian national survey. BMC Pregnancy Childbirth 2020; 20:717. [PMID: 33228597 PMCID: PMC7684922 DOI: 10.1186/s12884-020-03418-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 11/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnant women. Women after HDP have 2-3 times increased risk of heart attack, stroke and diabetes, as soon as 5-10 years after pregnancy. Australian healthcare providers' knowledge of cardiovascular disease (CVD) risks for women after HDP is unknown, and this study aimed to explore their current knowledge and practice regarding long-term cardiovascular health after HDP, as a precursor to producing targeted healthcare provider education on health after HDP. METHODS A custom-created, face-validated online survey explored knowledge about long-term risks after HDP. Distribution occurred from February to July 2019 via professional colleges, key organisations and social media. The objective was to assess current knowledge and knowledge gaps amongst a group of healthcare providers (HCP) in Australia, regarding long-term cardiovascular health after hypertensive disorders of pregnancy (HDP), specifically gestational hypertension or preeclampsia. RESULTS Of 492 respondents, 203 were midwives, 188 obstetricians, 75 general practitioners (GP), and 26 cardiologists. A risk knowledge score was computed with 0-6 considered low, 6.1-8.9 moderate and 9-12 high. Most participants (85%) were aware of increased cardiovascular disease after preeclampsia and gestational hypertension (range 76% midwives to 100% cardiologists). There were significant differences in average knowledge scores regarding health after preeclampsia; high for cardiologists (9.3), moderate for GPs and obstetricians (8.2 and 7.6 respectively) and low for midwives (5.9). Average knowledge scores were somewhat lower for gestational hypertension (9.0 for cardiologists, 7.4 for obstetricians and GPs, 5.1 for midwives). Knowledge was highest regarding risk of chronic hypertension, moderate to high regarding risk of ischaemic heart disease, stroke and recurring HDP, and low for diabetes and peripheral vascular disease. Only 34% were aware that risks start < 10 years after the affected pregnancy. CONCLUSION(S) Participants were aware there is increased cardiovascular risk after HDP, although less aware of risks after gestational hypertension and some specific risks including diabetes. Findings will inform the development of targeted education.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Burnet Institute, Maternal and Child Health, Melbourne, Victoria, Australia
| | - Clare Arnott
- The George Institute, Sydney, NSW, Australia.,Department of Cardiology, RPA, Sydney, NSW, Australia
| | - Lynne Roberts
- St George Hospital, Sydney, NSW, Australia.,St George & Sutherland Clinical School, UNSW, Sydney, NSW, Australia
| | - Mark Brown
- St George Hospital, Sydney, NSW, Australia.,St George & Sutherland Clinical School, UNSW, Sydney, NSW, Australia
| | - Amanda Henry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,The George Institute, Sydney, NSW, Australia.,St George Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of NSW, Sydney, NSW, Australia
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Hutchesson MJ, Taylor R, Shrewsbury VA, Vincze L, Campbell LE, Callister R, Park F, Schumacher TL, Collins CE. Be Health e for Your Heart: A Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women with a History of Preeclampsia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165779. [PMID: 32785044 PMCID: PMC7459885 DOI: 10.3390/ijerph17165779] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/07/2023]
Abstract
This pilot randomized controlled trial (RCT) aimed to determine the acceptability and preliminary efficacy of a web-based cardiovascular disease (CVD) prevention intervention for women following preeclampsia. Australian women with a recent history (≤4 years post diagnosis) of preeclampsia were randomized into two study arms: (1) Be Healthe for your Heart, a web-based behavioral intervention or; (2) Control, access to the National Heart Foundation website. Assessments were conducted at baseline, and after three months. Intervention acceptability and impact on absolute CVD 30-year risk score, CVD risk markers and health behaviors were assessed. Twenty-four of 31 (77.4%) women completed the three-month assessment. Eleven out of 13 intervention participants (84.6%) agreed/strongly agreed they were satisfied with the program, with a mean score of 4.2 ± 0.9 (maximum of five). There were no significant between or within group differences in absolute CVD risk, CVD risk markers or health behaviors from baseline to three months. Women with a history of preeclampsia were successfully recruited and retained and they reported high levels of acceptability with the Be Healthe for your Heart program. Further research is therefore needed from powered trials to determine the impact of web-based lifestyle interventions on CVD risk in this at-risk group.
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Affiliation(s)
- Melinda J. Hutchesson
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.T.); (V.A.S.); (T.L.S.); (C.E.C.)
- Correspondence:
| | - Rachael Taylor
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.T.); (V.A.S.); (T.L.S.); (C.E.C.)
| | - Vanessa A. Shrewsbury
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.T.); (V.A.S.); (T.L.S.); (C.E.C.)
| | - Lisa Vincze
- School of Allied Health Sciences & Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia;
| | - Linda E. Campbell
- School of Psychology, Faculty of Science, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Felicity Park
- Department of Maternal Foetal Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia;
| | - Tracy L. Schumacher
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.T.); (V.A.S.); (T.L.S.); (C.E.C.)
- Priority Research Centre for Health Behaviours, Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW 2340, Australia
| | - Clare E. Collins
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (R.T.); (V.A.S.); (T.L.S.); (C.E.C.)
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Henry A, Arnott C, Makris A, Davis G, Hennessy A, Beech A, Pettit F, Se Homer C, Craig ME, Roberts L, Hyett J, Chambers G, Fitzgerald O, Gow M, Mann L, Challis D, Gale M, Ruhotas A, Kirwin E, Denney-Wilson E, Brown M. Blood pressure postpartum (BP 2) RCT protocol: Follow-up and lifestyle behaviour change strategies in the first 12 months after hypertensive pregnancy. Pregnancy Hypertens 2020; 22:1-6. [PMID: 32679537 DOI: 10.1016/j.preghy.2020.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Women who had hypertensive disorders of pregnancy (HDP) are twice as likely to experience maternal cardiovascular disease later in life. The primary aim of this study (BP2) is to compare outcomes of 3 different management strategies, including lifestyle behaviour change (LBC), in the first 12 months postpartum in women who had HDP in their preceding pregnancy. Secondary aims include assessing the effects on other cardiometabolic parameters. STUDY DESIGN Three-arm multicentre randomised trial in metropolitan Australian hospitals, (registration: ACTRN12618002004246) target sample size 480. Participants are randomised to one of three groups: 1) Optimised usual care: information package and family doctor follow-up 6 months postpartum 2) Brief intervention: information package as per group 1, plus assessment and brief LBC counselling at a specialised clinic with an obstetric physician and dietitian 6 months postpartum 3) Extended intervention: as per group 2 plus enrolment into a 6 month telephone-based LBC program from 6 to 12 months postpartum. All women have an outcome assessment at 12 months. MAIN OUTCOME MEASURES Primary outcomes: (a) BP change or (b) weight change and/or waist circumference change. SECONDARY OUTCOMES maternal health-related quality of life, engagement and retention in LBC program, biochemical markers, vascular function testing, infant weight trajectory, incremental cost-effectiveness ratios. The study is powered to detect a 4 mmHg difference in systolic BP between groups, or a 4 kg weight loss difference/2cm waist circumference change. CONCLUSIONS BP2 will provide evidence regarding the feasibility and effectiveness of postpartum LBC interventions and structured clinical follow-up in improving cardiovascular health markers after HDP.
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Affiliation(s)
- Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia; Women's and Children's Health, St George Hospital, Kogarah, New South Wales, Australia; The George Institute for Global Health, Sydney, Australia.
| | - Clare Arnott
- The George Institute for Global Health, Sydney, Australia; Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia; Sydney Medical School, University of Sydney, Australia
| | - Angela Makris
- Faculty of Medicine, University of New South Wales, Sydney, Australia; School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Gregory Davis
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia; Women's and Children's Health, St George Hospital, Kogarah, New South Wales, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Amanda Beech
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Franziska Pettit
- Department of Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia; St George and Sutherland Clinical School, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Caroline Se Homer
- Burnet Institute, Melbourne, Victoria, Australia; Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Maria E Craig
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia; Women's and Children's Health, St George Hospital, Kogarah, New South Wales, Australia
| | - Lynne Roberts
- Women's and Children's Health, St George Hospital, Kogarah, New South Wales, Australia; St George and Sutherland Clinical School, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Jon Hyett
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, Australia
| | - Georgina Chambers
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health and Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Oisin Fitzgerald
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health and Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Megan Gow
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Linda Mann
- General Practitioner, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Daniel Challis
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia; Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Marianne Gale
- New South Wales Ministry of Health, North Sydney, New South Wales, Australia
| | - Annette Ruhotas
- Women's and Children's Health, St George Hospital, Kogarah, New South Wales, Australia
| | - Emilee Kirwin
- Women's and Children's Health, St George Hospital, Kogarah, New South Wales, Australia
| | | | - Mark Brown
- Department of Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia; St George and Sutherland Clinical School, UNSW Medicine, University of New South Wales, Sydney, Australia
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