Hanna Ulfsdottir

Background: Preeclampsia (PE), a severe hypertensive disorder affecting about 5% of all primiparous pregnancies, is strongly associated with complications in subsequent pregnancies and early-onset of cardiovascular diseases (CVD) as myocardial infarction and stroke. Traditional CVD risk factors arising after pregnancy are strongly associated with the increased CVD risk in women with previous PE, with pregnancy weight retention and overweight/obesity being key modifiable factors. Thus, the first postpartum phase provides a window of opportunity for screening and implementing preventive interventions. Given this, there is a high clinical need for evidence-based postpartum interventions that can mitigate the risk of future overweight/obesity and to improve the cardiometabolic profile, to potentially delay or prevent future CVD. Objectives: The overall aim is to address the lack of evidence to improve cardiometabolic health in women with previous PE. With a multidisciplinary team including representatives from the PE Patient Organisation and informed by a feasibility study, we will evaluate the efficacy of a clinically implementable bundle intervention program tailored for postpartum women with PE in first pregnancy. Our hypothesis is that the intervention will be feasible with high compliance, and effective in reducing postpartum maternal BMI and improve cardiometabolic profile 1 year after birth. Work plan: We will conduct a multi-centre two-armed single-blind parallel randomised controlled trial of 700 participants (350 in each arm), between 3 to 12 months postpartum, among primiparous PE women. Participants will be allocated either a bundle intervention or standard care. The intervention includes a combination of information, targeted screening and healthy lifestyle promotion, including physical activity and a healthy diet through support by study personnel and an interactive Smartphone-App. The primary outcome will be change in BMI between baseline and follow-up. Significance: Clinically, this group of women with increased CVD-risks is often left without support. If the bundle intervention proves to be superior to standard care, implementation of the program into clinical care could improve the cardiometabolic profile of women with previous PE and potentially prevent future CVD. Furthermore, the intervention could be expanded to women with other pregnancy complications associated to CVD and parous women with PE.

About 15% of mothers suffer from postpartum depression, which besides their suffering often affects the relation to the child and partner negatively. Depression during pregnancy constitutes a high risk for postpartum depression, and better screening and access to treatment is needed.Mom2B is a mobile application aimed towards all pregnant individuals, and includes screening for depression. If detected, general information regarding health care for depression is presented. We want to randomize half of these indicated risk users to instead receive targeted information about guided, internet-based CBT (ICBT) for depression during pregnancy.Our hypothesis is that more of these will start our evidence-based ICBT and lower their symptom levels and risk for postpartum depression 8-10 weeks after delivery, measured with structured interview and registry data. We also expect the strategy with targeted information and ICBT to be beneficial from a health economic perspective. ICBT is preceded by an assessment, and during the 12-week treatment the participant works with a self-help material while actively supported by a psychologist via text messages. We have evaluated the ICBT-program used in this study with positive results, but in line with other research on ICBT we have seen that more support and adjustments are often asked for. In line with Personalized Care, we will thus randomize some of those seeking ICBT, via Mom2B or other channels, to receive more personalized care by letting them choose type of visits (physical/video/telephone) and get extra visits with a midwife with the purpose of better adjusting the care to their needs. Others will receive no extra visits and are randomized to type of visit. For sub-analyses, some also choose type of visit but receive no extra visits, and vice versa.Our hypothesis is that personalized ICBT will lead to increased treatment engagement and patient empowerment, as well as reduced symptoms and risk for postpartum depression.