Dekker, GustaafArstall, MargaretRoberts, ClaireAldridge, Emily Louise2023-05-042023-05-042022https://hdl.handle.net/2440/138225Background: Cardiovascular disease (CVD) is a leading cause of death in Australia and globally. CVD outcomes in women are worse compared to men, and even more so for women from socioeconomically disadvantaged communities. An important, but often overlooked, risk factor for CVD in women is development of hypertensive and metabolic complications of pregnancy. Women who experience at least one of these complications, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, spontaneous preterm birth, or placental abruption, are at significantly greater risk of developing CVD in the future compared to women with uncomplicated pregnancies. Preventative care introduced early after complicated pregnancies may assist in reducing the risk of CVD but limited postpartum follow-up services are available both in Australia and worldwide. The broad aim of the research presented in this thesis is to describe the cardiometabolic and mental health of women attending a novel postpartum intervention that aims to reduce cardiovascular risk after complications of pregnancy. Methods: This thesis includes five distinct, but related, studies and a protocol publication. The group of studies is comprised of one methods optimisation study and four analyses of prospectively collected registry data. The protocol publication detailed the creation of a novel nurse practitioner-led postpartum intervention clinic and associated clinical data registry. The optimisation study compared automated blood pressure devices against the aneroid gold-standard method for use in a perinatal population. The individual registry analyses focused on data collected from a population of socioeconomically disadvantaged women who had recently given birth following a complicated pregnancy and attended postpartum clinic appointments at six months and eighteen months postpartum. The first registry analysis was an exploration of the prevalence of metabolic syndrome after six months postpartum. Secondly, cardiovascular risk awareness at six months postpartum was investigated. Thirdly, this research investigated the change in metabolic syndrome status over time after receiving the postpartum intervention. Finally, the relationships between complications of pregnancy, metabolic syndrome, and mental health outcomes at six months postpartum were explored. Results: The optimisation study identified two automated alternatives to aneroid blood pressure measurement in the antenatal period. The registry analyses demonstrated a high prevalence (36%) of metabolic syndrome in the cohort of women six months after a complication of pregnancy. Awareness of the link between complications of pregnancy and future cardiovascular disease was low, with 69.1% reporting that they were unaware of the increased risk. There was a modest reduction in the percentage of metabolic syndrome at eighteen months postpartum compared to six months postpartum (34.4% reduced to 29.7%), although this was not statistically significant. Finally, women with metabolic syndrome reported more subjective mental health concerns at six months postpartum and were more likely to be using psychotropic medication (16.9% compared to 8.6%, p<0.05), but there were no significant differences between depression and anxiety screening scores. Conclusions: A significant number of women experience adverse cardiometabolic and mental health after complications of pregnancy, detectable as early as six months postpartum. The results reported in this study are an important step in the introduction and optimisation of postpartum CVD prevention services to high-risk women who identify their vulnerability during pregnancy by developing a major complication. Increasing awareness and education in this group will empower women to take control of their own health, improve the health of their families, and may eventually lead to a reduction in the significant burden of chronic disease that characterises low socioeconomic populations.enpregnancy, cardiometabolic disease, maternal health, disease preventionThesis