Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Experiences after Hypertensive Disorders of Pregnancy (women’s “post-HDP world”): a Blood Pressure Postpartum (BP2) sub-study (#88)

Amanda Henry 1 2 3 , Christine Rossiter 4 , Lynne Roberts 2 5 , Clare Arnott 3 6 , Justine Salisbury 7 , Kate Reid 7 , Annette Ruhotas 8 , Elizabeth Denney-Wilson 9 , On behalf of the BP2 Steering Committee 10
  1. School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
  2. Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia
  3. The George Institute for Global Health, Sydney, NSW, Australia
  4. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  5. St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
  6. Royal Prince Alfred Hospital, Sydney, NSW, Australia
  7. Centre for Population Health, NSW Ministry of Health, Sydney, NSW
  8. Consumer Respresentative, Maternal, Newborn and Women's Clinical Academic Group, SPHERE, Sydney, NSW
  9. Faculty of Nursing, Sydney University, Sydney, NSW, Australia
  10. Blood Pressure Postpartum (BP2) Steering Committee, Sydney

Background

Hypertensive disorders of pregnancy (HDP) not only affect pregnancy outcomes but have implications for women’s ongoing health, including at least double the lifetime risk of cardiovascular disease and Type II diabetes. BP2 is a currently recruiting, 3-arm randomised trial of follow-up and lifestyle behaviour change strategies in the first year after HDP (Optimised Usual Care with GP; Brief Education Intervention with physician/dietitian at Postpartum Clinic; Extended Lifestyle Intervention including 6 months Get Healthy Service telephone-based coaching). This qualitative sub-study within BP2 aimed to investigate the barriers and enablers to healthy behaviours after a pregnancy complicated by HDP.

Methods

Thirty-four women from all three arms of BP2 were interviewed March 2020-April 2021, approximately 10-12 months postpartum (4-6 months after randomisation and intervention commencement). The semi-structured interviews were conducted by telephone, transcribed verbatim prior to thematic analysis, following the methods suggested by Braun and Clarke.

Results

The interviews explored women’s experiences following a HDP. Major themes included:

  • Impact of a young baby on healthy lifestyles (exhaustion, limited time, costs, other priorities)
  • Importance of support (partners, extended family, Get Healthy Service/BP2 intervention)
  • Awareness of HDP-related risks (varied recognition of risk of future CVD, BP2 intervention brought greater awareness).
  • Moving on (plans for return to work both negative and positive impacts, baby developing, future pregnancies, post-COVID world)

Conclusion

Interviewees outlined varying views of their post-HDP world. Some women clearly embraced the future health implications and their ability to positively influence this through lifestyle, while others appeared overwhelmed by their current parenting demands. Perceptions varied with individual circumstances including support, previous experience of healthy practices, finances and access to the full intervention. Findings support potential utility of structured post-HDP follow-up, including psychosocial supports, and postpartum lifestyle intervention. However, future interventions should recognise that timing (and degree) of women’s readiness to engage shows considerable variation.