Abstract
BACKGROUND: Preeclampsia is associated with a 2 to 3-fold increased risk for future maternal cardiovascular disease (CVD).To reduce CVD risk and overcome participation barriers, we tested an online intervention to promote a healthy lifestyle among women with recent preeclampsia. METHODS: We conducted a 9-month randomized controlled trial among 151 US women with preeclampsia within the prior 5 years. Preeclampsia history was validated by medical record review for new-onset hypertension (systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mm Hg) with proteinuria (≥ 300 mg/24hr, or urine protein/urine creatinine ratio ≥ 0.3 or urine dipstick ≥ 1+) after 20 weeks gestation. The intervention group received a patient-centered program, Heart Health 4 Moms (HH4M), created with input from preeclampsia survivors and the Preeclampsia Foundation. The program, available in English and Spanish, included online educational modules, a community forum, heart healthy resources (e.g., meal plans), and communication with a lifestyle coach including 6 scheduled phone calls. The control group received access to a website with links to CVD risk reduction websites accessible to the general public. Primary outcomes were self-efficacy for healthy eating and increasing physical activity; change in physical activity/inactivity; adherence to the Dietary Approaches to Stop Hypertension diet; and knowledge of and personal control over CVD risk. Secondary outcomes were weight and blood pressure. We used the Hochberg method to adjust the p value for multiple comparisons. RESULTS: Participants were, on average, 31 years of age, 1.3 years removed from their preeclampsia pregnancy, predominantly non-Hispanic white and resided in 41 US states. Retention rates were high (control 93%; intervention 91%). During the 9 months of follow-up, 69% of control participants and 99% of intervention participants visited the study website (p<0.00001). In the intervention arm, 84% of participants accessed at least one online educational module and 89% completed at least three scheduled calls with the coach. At the end of follow-up, intervention participants reported increased self-efficacy for healthy eating (p=0.03), greater knowledge of CVD risk factors (p=0.01), and less physical inactivity (p=0.0006) than individuals in the control arm. The groups did not differ in personal control over CVD risk, self-efficacy for physical activity, or reported physical activity levels. There were no differences in secondary outcomes between groups. CONCLUSIONS: The on-line HH4M program was used by women with recent preeclampsia across the US, improved their self-efficacy to achieve a healthy diet and their knowledge of CVD risk and reduced their physical inactivity. HH4M provides a model for an on-line, easily-accessible lifestyle program to reduce CVD risk in women with recent preeclampsia. (Funded by PCORI).