Prioritisation of where and when to initiate a lifestyle intervention to reduce cardiometabolic disease risk in high-risk pregnant and postpartum women: a mixed method workshop

Cardiometabolic pregnancy complications, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR) and preterm birth (PTB) are prevalent pregnancy complications that adversely affect maternal and neonatal health during pregnancy, and increase women’s risk of future type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) 1–5 . Pregnancy and postpartum, including intrapartum periods, are critical windows of opportunity to deliver care to support sustained behaviour change (6) . There is currently a gap in lifestyle (diet and physical activity) interventions specific to cardiometabolic disease risk awareness and prevention during and following pregnancy (5,7) . These are key life stages where early risk factors for cardiometabolic disease may present, women are actively engaged in the healthcare system and their health priorities are shifting as they transition into parenthood. Early intervention in pregnancy may enable commencement of pharmacological and/or lifestyle intervention to reduce the risk or severity of cardiometabolic pregnancy complications (8) , whereas postpartum intervention may enable commencement of sustainable lifestyle change for reduction of long-term cardiometabolic risks (9) . There are a range of settings where pregnant and postpartum women receive healthcare, including hospitals, primary care clinics, community health institutions and online platforms (8,10,11) . The optimum timing and setting to deliver an intervention to these high-risk women is not known. Designing interventions to align with the needs and priorities of stakeholders is a critical first step in developing an acceptable intervention. The aims of this research were to explore stakeholder perspectives and prioritise the optimal timing and setting to deliver a lifestyle intervention to improve long-term cardiometabolic health amongst women at high-risk of or diagnosed with a cardiometabolic pregnancy complication. An embedded mixed-methods research design was utilised. Facilitator-led workshops were used to prioritise the preferred timing (pregnancy or postpartum) and setting (hospital, general practice, community health program, maternal and child health services or online) for an intervention. Women with prior GDM, HDP, IUGR and/or PTB (n = 9), and research partners (n = 15) (obstetricians, endocrinologists, community health representatives, researchers, midwife, general practitioner, dietitian) participated. Workshops were audio recorded, transcribed verbatim and thematically analysed using template analysis. Online polls were used to assess participants preferred timing and setting for an intervention. Women preferred a postpartum intervention delivered online, whereas research partners preferred a pregnancy intervention delivered via hospital antenatal care. Both groups suggested commencing interventions during pregnancy and continuing postpartum. Participants recommended ensuring interventions consider healthcare system barriers to intervention delivery, equity and sustainment, as well as consumer-specific barriers to intervention engagement and lifestyle change during pregnancy and postpartum. Commencing patient-centred interventions during pregnancy and continuing postpartum should be considered to support continuity of care and improve health outcomes across both life stages for this high-risk group of women.