Abstract P146: The Effects of Lifestyle Interventions on Blood Pressure in Postpartum Women: A Systematic Review

Introduction: One in 3 parous individuals has a pregnancy complication that indicates increased risk for future hypertension, diabetes, or heart disease. Lifestyle modification is recommended to reduce chronic disease risk after complicated pregnancies. However, little is known about the effect of lifestyle interventions on blood pressure in postpartum women. Thus, our objective was to evaluate the effects of postpartum lifestyle interventions on blood pressure. We hypothesized that postpartum lifestyle interventions would be associated with a decrease in blood pressure. Methods: We conducted a systematic literature review of six databases (Google, Google Scholar, Embase, Clinical Trials.gov, Cochrane Central, and PubMed) for relevant articles published through May 12, 2022. We considered for inclusion any randomized controlled trial or quasi-experimental, cohort, or case-control study that evaluated a postpartum lifestyle intervention and included blood pressure as an outcome. We excluded non-English publications and articles published before 2010. Two researchers independently identified eligible publications via title and abstract screening followed by full-text review, then extracted relevant data; a third researcher resolved any discrepancies. Due to the heterogeneity of the included studies, we were not able to conduct statistical testing. Results: In total 2,564 unique publications underwent title and abstract screening, of which 32 underwent full-text review, and eight met the inclusion criteria. Six of the included studies were randomized controlled trials, and five had relatively small sample sizes (<100). In studies that reported race, nearly all participants identified as White (82%-100%). Seven of the studies required participants to have a history of a pregnancy complication, most often preeclampsia. Interventions usually involved diet and exercise counseling; only two included supervised exercise. Mean blood pressure declined from baseline to follow-up in all of the studies, however in none was there a statistically significant difference in blood pressure change between the intervention and control groups. While not statistically significant, the interventions that included supervised exercise appeared to be associated with greater blood pressure reductions when compared with control, than were the unsupervised interventions. Conclusions: In conclusion, we found no statistically significant effects of postpartum lifestyle interventions on blood pressure. Supervised exercise interventions appeared most promising. The evidence is limited to a handful of published studies (n=8) characterized by small sample sizes and a lack of racial diversity. Additional research with more diverse populations and supervised exercise interventions are warranted.