Maria (Mia) Ahlberg

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.

Purpose: To increase person-centred care during labor. Specifically, we want to provide updated comprehensive information on labor duration and patient safety for reduction of

unnecessary medical interventions during normal labor

morbidity and mortality in the new-born

maternal complications during delivery and the puerperal period.Specific Aims:    Identify risk groups where labor duration means particularly high risks    Identify groups where labor duration has little or no influence on serious complications    Identify upper time limits for excessively long laborMethod: Cohort studies, Case-control studies, and risk prediction studies.Plan for project realizationThe project is carried out at Karolinska Institutet  at the Clinical Epidemiology Division where ethical permissions, data, and software are already available.The reproductive perinatal research group has the clinical, epidemiological and statistical knowledge to adequately formulate, analyze, and answer the research questions. The project will be carried out during 2024-2026.Importance:It is known that prolonged labor duration is associated with very serious complications for some women and infants. Which women and featuses that are at increased risk if labor continues and when labor duration becomes dangerous is still unknown. The results from this project will contribute with important knowledge when preventive interventions are important and when expectant management is preferred.