Pre-eclampsia and Future Cardiovascular Health: An Underused Opportunity to Improve Family Health (FINNCARE)

Background: PE (pre-eclampsia) is a common pregnancy-specific vascular hypertensive disease affecting 3-5% of pregnancies. PE independently increases the risk for premature cardiovascular disease (CVD) in mothers and their offspring long-term. PE provides a unique window for early risk profiling and CVD prevention. However, the efficacy of a family oriented lifestyle intervention to lower CVD risk in families with history of PE has not previously been evaluated.

Aim: This study will explore the impact of PE on CVD progression 8-12 years from delivery in mothers and their children, and assess whether a lifestyle intervention is useful for lowering mother and child blood pressure and improving the CVD risk profile overall in families with a history of PE.

Hypothesis: PE is related with CVD progression mediated by elevated blood pressure. Blood pressure and the CVD risk profile overall is modifiable in mothers and children by a 12-month behavioral lifestyle intervention in families with a history of PE.

Study design: Randomized controlled behavioral lifestyle intervention trial where families (mother, child and father from the FINNPEC study) are offered the opportunity to participate in a lifestyle intervention program 8-12 years after a PE pregnancy. 300 PE families will be randomized 1:1 to a 12-month lifestyle intervention program or to a control group. A parallel group of 100 non-PE control families will be assessed at baseline and follow-up.

Main outcome: 24 hour mean blood pressure change between baseline and follow-up in mother and child.

Significance: This study will provide information on CVD progression in mothers and children 8-12 years from a PE pregnancy. Furthermore, the study assess the effect of a 12-month lifestyle intervention on blood pressure and CVD risk profile overall following a PE pregnancy. Potentially, the study provides the opportunity to identify PE families at highest risk of CVD progression and families amenable to blood pressure and CVD risk profile improvement.

Study Overview

• Status: Recruiting
• Conditions: Cardiovascular Diseases; Pre-Eclampsia; Cardiovascular Risk Factor; Gestational Hypertension
• Intervention / Treatment: Behavioral: Face-to-face and web-based lifestyle intervention

Detailed Description

Power analysis:

Power calculations were performed in order to detect 5.5 mmHg reduction in maternal systolic blood pressure with a power of 80% and a 2-sided p-value of 0.05 for the difference between the groups (intervention and control PE) (NICE 2011). Accounting for a 20% loss to follow-up or missing data, a sample of 148 women in the PE intervention group and 148 women in the PE control group is needed.

Specific objectives:

1. To assess cardiovascular health and CVD progression in families (mother, child and father) 8-12 years following a PE pregnancy compared with non-PE control families.
2. To assess the effectiveness of a behavioral 12-month lifestyle intervention in mothers and their children 8-12 years following a PE pregnancy to lower blood pressure and improve their CVD risk profile overall.
3. To assess the effectiveness of a lifestyle intervention on the awareness of CVD risk after a PE pregnancy.

• Study Type: Interventional
• Enrollment (Anticipated): 400
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tiina Jääskeläinen, PhD; Phone Number: +358 50 4150274; Email: tiina.j.jaaskelainen@helsinki.fi
• Study Contact Backup: Name: Taisto Sarkola, PhD, MD; Phone Number: +358504274971; Email: taisto.sarkola@hus.fi

Study Locations

• Finland
  • Helsinki, Finland, 00029
    • Recruiting
    • Helsinki University Hospital
    • Contact: Taisto Sarkola, PhD, MD; Phone Number: +358504274971; Email: taisto.sarkola@hus.fi

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Families are recruited from the FINNPEC cohort. In FINNPEC, PE was defined as hypertension and proteinuria occurring after 20 weeks gestation (American College of Obstetricians and Gynecologists 2002 criteria). Hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Proteinuria was defined as urinary excretion of ≥0.3 g protein in a 24-hour specimen, or 0.3 g/L, or two ≥1+ readings on a dipstick in a random urine determination with no evidence of a urinary tract infection. Each PE diagnosis was ascertained based on hospital records and confirmed independently by a research nurse and a study physician in the original FINNPEC case-control study including 1450 nulliparous or multiparous women with a singleton pregnancy with PE and 1065 pregnant control women without PE (aged 18-47 years) from all 5 university hospitals in Finland during 2008-2011.

Exclusion criteria in the FINNPEC: multiple pregnancy, inability to speak Finnish or Swedish.

Exclusion Criteria in the FINNCARE:

• Pregnancy and/or lactation (for all mothers)
• Pre-eclampsia in any previous or subsequent pregnancies (for all non-PE mothers)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PE intervention; A 12-month lifestyle intervention program to improve mothers and their children blood pressure and CVD risk profile.	Behavioral: Face-to-face and web-based lifestyle intervention; Families are provided at baseline with one 60 min face-to-face dietary counseling session with nutritionist using family-oriented motivational interviewing and solution focusing techniques. The intervention continues in an interactive web-based portal where different modules include assignments, activities, and tests and related videos targeting five cardiovascular health-linked behaviors: 1) improving quality of fat in the diet, 2) increasing the consumption of foods rich in fiber, 3) decreasing the use of salt, 4) increasing physical activity and 5) reducing smoking.
No Intervention: PE control; The control group continue habitual lifestyle but will perform the same baseline and follow-up measurements as the intervention group. They will be given general written information on healthy eating.
No Intervention: Non-PE control; The control group continue habitual lifestyle but will perform the same baseline and follow-up measurements as the intervention group. They will be given general written information on healthy eating.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood pressure (mothers)	mean 24 hour ambulatory systolic BP and diastolic BP; mmHg	baseline -12 months
Blood pressure (children)	mean 24 hour ambulatory systolic BP and diastolic BP; mmHg	baseline -12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood pressure 24 hour variability (mothers)	nocturnal systolic and diastolic BP dip; standard deviation of systolic and diastolic BP; weighted standard deviation of systolic and diastolic BP; mmHg	baseline -12 months
Arterial stiffness (mothers)	carotid-femoral pulse wave velocity; m/s	baseline -12 months
Adiposity (mothers)	BMI; kg/m2	baseline -12 months
Adiposity (mothers)	waist-hip-ratio (no unit)	baseline -12 months
Adiposity (mothers)	body fat percentage; %	baseline -12 months
Dietary intake (mothers)	food frequency questionnaire on quality of fat (SFA, MUFA and PUFA; E%/day)	baseline -12 months
Dietary intake (mothers)	food frequency questionnaire on fiber intake; g/day	baseline -12 months
Dietary intake (mothers)	food frequency questionnaire on salt intake; g/d	baseline -12 months
Physical activity and sedentary behavior (mothers)	questionnaire data: weekly number of sessions and minutes of moderate-to-vigorous-intensity physical activity and walking	baseline -12 months
Physical activity and sedentary behavior (mothers)	questionnaire data: meeting physical activity recommendations	baseline -12 months
Physical activity and sedentary behavior (mothers)	questionnaire data: daily minutes of sitting on a non-weekend and weekend day	baseline -12 months
Physical activity and sedentary behavior (mothers)	accelerometer data: daily number of steps	baseline -12 months
Physical activity and sedentary behavior (mothers)	accelerometer data: daily minutes of total and intensity-specific physical activity	baseline -12 months
Physical activity and sedentary behavior (mothers)	accelerometer data: daily minutes of stationary behavior	baseline -12 months
Physical activity and sedentary behavior (mothers)	accelerometer data: daily number of breaks in stationary behavior	baseline -12 months
Smoking (mothers)	questionnaire on status of smoking/use of snuf/use of electronic cigarettes/nicotine replacement therapy and number of cigarettes/day	baseline -12 months
Laboratory assessment of cardiovascular risk (mothers)	lipids (total cholesterol, LDL, HDL, triglycerides; mmol/l)	baseline -12 months
Laboratory assessment of cardiovascular risk (mothers)	hs-CRP; mg/l	baseline -12 months
Laboratory assessment of cardiovascular risk (mothers)	HOMA index calculated as glucose; mmol/l x insulin; mU/l / 22.5	baseline -12 months
Awareness of later life morbidity (mothers)	A brief questionnaire with true or false questions on pre-eclampsia and later life morbidity	baseline -12 months
Heart rate variability (mothers)	standard deviation of all R-R intervals; root mean square of successive R-R interval differences, ms; High frequency power of R-R intervals from spectral band 0.15-0.4 Hz, ms2 ;Low frequency power of R-R intervals from spectral band 0.04-0.15 Hz, ms2 ; and LF/HF ratio	baseline -12 months
Blood pressure 24 hour variability (children)	nocturnal systolic and diastolic BP dip; standard deviation of systolic and diastolic BP; weighted standard deviation of systolic and diastolic BP; mmHg	baseline -12 months
Arterial stiffness (children)	carotid-femoral pulse wave velocity; m/s	baseline -12 months
Adiposity (children)	BMI z-score	baseline -12 months
Adiposity (children)	waist-hip-ratio (no unit)	baseline -12 months
Adiposity (children)	body fat percentage; %	baseline -12 months
Dietary intake (children)	food frequency questionnaire derived data on SFA index, fiber index, salt index (sum of food items rich in SFA/fiber/salt used during the previous week)	baseline -12 months
Physical activity and sedentary behavior (children)	questionnaire data: weekly number of days and daily duration of active travel to school and hobbies, structured physical activity outside school hours, unstructured physical activity outside school hours, screen time sitting, non-screen time sitting Accelerometer data: daily number of steps; daily minutes of total and intensity-specific physical activity; daily minutes of and stationary behavior; meeting physical activity recommendations; daily number of breaks in stationary behavior	baseline -12 months
Physical activity and sedentary behavior (children)	questionnaire data: weekly number of days and daily duration of active travel to school and hobbies	baseline -12 months
Physical activity and sedentary behavior (children)	questionnaire data: structured physical activity outside school hours	baseline -12 months
Physical activity and sedentary behavior (children)	questionnaire data: unstructured physical activity outside school hours	baseline -12 months
Physical activity and sedentary behavior (children)	questionnaire data: screen time and non-screen time sitting	baseline -12 months
Physical activity and sedentary behavior (children)	accelerometer data: daily number of steps	baseline -12 months
Physical activity and sedentary behavior (children)	accelerometer data: daily minutes of total and intensity-specific physical activity	baseline -12 months
Physical activity and sedentary behavior (children)	accelerometer data: daily minutes of stationary behavior	baseline -12 months
Physical activity and sedentary behavior (children)	accelerometer data: meeting physical activity recommendations	baseline -12 months
Physical activity and sedentary behavior (children)	accelerometer data: daily number of breaks in stationary behavior	baseline -12 months
Laboratory assessment of cardiovascular risk (children)	lipids (total cholesterol, LDL, HDL, triglycerides; mmol/l)	baseline -12 months
Laboratory assessment of cardiovascular risk (children)	hs-CRP; mg/l	baseline -12 months
Laboratory assessment of cardiovascular risk (children)	HOMA index calculated as glucose; mmol/l x insulin; mU/l / 22.5	baseline -12 months
Process evaluation: reach	participation rate of the families recruited (research database on study visits)	baseline
Process evaluation: reach	representativeness of the families participating (parents' and children's age, questionnaire on socio-economics)	baseline
Process evaluation: compliance	participation rate in measurements (number of study visits and questionnaires completed)	baseline -12 months
Process evaluation: compliance	proportion of sessions completed in the web-based portal (data accumulated in the web-based portal)	baseline -12 months
Process evaluation: acceptability	usefulness and ease of use (questionnaire and proportion of webportal sessions completed by the families)	baseline -12 months
Process evaluation: acceptability	credibility and satisfaction of the web-based portal (questionnaire and proportion of webportal sessions completed by the families)	baseline -12 months
Process evaluation: acceptability	occurrence of technical problems (questionnaire)	baseline -12 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Arterial wall thickness (mothers)	intima-media thickness; common carotid, brachial and radial; mm	baseline
Left ventricular mass (mothers)	left ventricular mass; g	baseline
Left ventricular systolic function (mothers)	left ventricular global longitudinal strain; %	baseline
Left ventricular diastolic function (mothers)	left atrial volume; ml	baseline
Left ventricular diastolic function (mothers)	pulsed wave Doppler mitral early to late inflow velocity ratio (no unit)	baseline
Left ventricular diastolic function (mothers)	mitral lateral annular pulsed wave tissue Doppler early velocity; cm/s	baseline
Left ventricular diastolic function (mothers)	septal pulsed wave tissue Doppler early velocity; cm/s	baseline
Arterial wall thickness (children)	intima-media thickness; common carotid, brachial and radial; mm	baseline
Left ventricular mass (children)	left ventricular mass; g	baseline
Left ventricular systolic function (children)	left ventricular global longitudinal strain; %	baseline
Left ventricular diastolic function (children)	left atrial volume; ml	baseline
Left ventricular diastolic function (children)	pulsed wave Doppler mitral early to late inflow velocity ratio (no unit)	baseline
Left ventricular diastolic function (children)	mitral lateral annular pulsed wave tissue Doppler early velocity; cm/s	baseline
Left ventricular diastolic function (children)	septal pulsed wave tissue Doppler early velocity; cm/s	baseline

Collaborators and Investigators

• Sponsor: Helsinki University Central Hospital
• Collaborators: University of Helsinki
• Investigators: Principal Investigator: Tiina Jääskeläinen, PhD, University of Helsinki; Study Chair: Hannele Laivuori, Prof, MD, University of Helsinki and University of Tampere; Study Director: Taisto Sarkola, PhD, MD, Helsinki University Central Hospital

Publications and helpful links

General Publications

• Jaaskelainen T, Heinonen S, Kajantie E, Kere J, Kivinen K, Pouta A, Laivuori H; FINNPEC Study Group. Cohort profile: the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC). BMJ Open. 2016 Nov 10;6(11):e013148. doi: 10.1136/bmjopen-2016-013148.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2019
• Primary Completion (Anticipated): December 1, 2022
• Study Completion (Anticipated): December 1, 2024

Study Registration Dates

• First Submitted: December 7, 2020
• First Submitted That Met QC Criteria: December 14, 2020
• First Posted (Actual): December 21, 2020

Study Record Updates

• Last Update Posted (Actual): December 21, 2020
• Last Update Submitted That Met QC Criteria: December 14, 2020
• Last Verified: December 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Vascular Diseases; Pregnancy Complications; Hypertension; Cardiovascular Diseases; Eclampsia; Pre-Eclampsia; Hypertension, Pregnancy-Induced
• Other Study ID Numbers: FINNCARE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No