Postpartum CO Rehabilitation

Postpartum Cardio-obstetric Rehabilitation After Hypertensive Pregnancy

Some women who develop high blood pressure during pregnancy, such as gestational hypertension or preeclampsia, may continue to have slightly or moderately high blood pressure after giving birth. This can increase their risk of heart disease later in life. Managing blood pressure and adopting a healthy lifestyle after pregnancy could help lower this risk.

Right now, the investigators don't know much about how postpartum rehabilitation programs focused on heart and pregnancy-related health could help women with these conditions. However, a feasibility study suggests that exercise programs might help reduce blood pressure and encourage healthier lifestyles in these women.

In this study, the investigators are testing an 8-week exercise program to see how it affects blood pressure, fitness, and blood vessel health. The investigators will compare the results with a group of women who receive usual healthcare, which includes verbal advice on healthy living but no supervised exercise sessions.

This type of program, called cardio-obstetric rehabilitation, combines exercises for heart health with specialized care for women's health.

Study Overview

• Status: Not yet recruiting
• Conditions: Gestational Hypertension; Preeclampsia (PE)
• Intervention / Treatment: Other: Postpartum Cardio-obstetric Rehabilitation Program

Detailed Description

Women with severe hypertensive disorders during pregnancy, such as preeclampsia (PE), have a higher risk of heart disease and stroke within five to 10 years of their pregnancy. Because their blood pressure (BP) drops in the postpartum period in comparison to the values they had during pregnancy, the hypertensive disorder can be considered resolved. However, recent studies have shown that their postpartum BP may be higher than before pregnancy. Hypertensive pregnancy has been associated with endothelial and microvascular dysfunction and capillary rarefaction, which could be the key mechanism leading to elevated BP in the postpartum period. Studies have shown that physical exercise promotes BP reduction, stimulates angiogenesis and improves microcirculation in healthy subjects, but also in patients with cardiovascular and metabolic diseases. Therefore, interventions to better monitor BP combined with a healthy lifestyle could help reduce the risk of heart disease in later years. The effects of postpartum cardio-obstetric rehabilitation in women with gestational hypertension (GH) or PE are still unknown. It is of interest to determine whether a postpartum cardio-obstetric rehabilitation program could reduce BP, identifying the possible mechanisms, and stimulate the adoption of a healthy lifestyle with potential long-term health benefits for women.

The main objective of this study is to describe the effects of an 8-week rehabilitation program combining aerobic exercise with obstetric rehabilitation starting between 3 to 6 months postpartum on BP changes, vascular structure and physical activity levels, which could lead to long term health benefits compared to usual care in women with previous GH and PE. The 8-week rehabilitation program will include cardiac (aerobic exercise) and obstetric (pelvic floor training, core and balance) exercises, as well as online education courses about healthy lifestyle. The outcomes will be compared with participants submitted to the usual care in the postpartum. At the end of the study participation period, participants of the control group will be offered to participate in the intervention program (crossing study).

The following outcomes will be evaluated, before and immediately after the intervention: ambulatory and 24-hour BP, arterial stiffness, pulse wave velocity, static retinal vessels analysis, body composition (including body mass index), physical capacity (6-minute walk test), physical activity level (number of daily steps), lipid and glucose profiles, quality of life (SF-36), as well as plasmatic angiogenic biomarkers and the angiogenic function of circulating endothelial cells. Moreover, 6-months post-intervention, participants will be submitted again only to physical evaluation to assess the long-term effects of the intervention program.

Cardio-obstetric rehabilitation is a new field, lacking the description and evaluation of effective programs. The investigators expect that the results obtained from this study will contribute to the design of a patient-oriented rehabilitation program. Our findings will provide the first evidence to support postpartum rehabilitation services in clinics which in turn could lead to long term health benefits to women.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mariane Bertagnolli, PhD, Professor; Phone Number: 2501 514-388-2222; Email: mariane.bertagnolli.cnmtl@ssss.gouv.qc.ca
• Study Contact Backup: Name: Rafael O Fernandes, PhD; Email: rafael.fernandes@muhc.mcgill.ca

Study Locations

• Canada
  • Quebec
    • Montreal, Quebec, Canada
      • Hôpital du Sacre-Coer de Montréal - CIUSSS du Nord-de-l'Île-de-Montréal
      • Contact: Julie Hammamji; Phone Number: 3316 (514) 384-2000; Email: julie.hammamji.cnmtl@ssss.gouv.qc.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• are 3 to 6 months postpartum, willing, and able to give informed consent for participation;
• are more than 18 years old;
• are able to access and use a computer, mobile phone and internet (for online sessions);
• were diagnosed with GH (BP higher than 139/89 mmHg after 20 gestational weeks) or PE (BP higher than 139/89 mmHg and proteinuria after 20 gestational weeks) during pregnancy.

Exclusion Criteria:

• have chronic (pre-existing) hypertension (BP>139/89 mmHg pre-pregnancy, <20 weeks' gestation or after 6 weeks postpartum);
• received antihypertensive drug therapy prior to pregnancy or after 6 weeks postpartum;
• are taking beta-blockers for any reason;
• participated in exercise activity programs regularly before 3-month postpartum (more than 2 hour of moderate-to-vigorous exercise per week);
• have any musculoskeletal injury that can limit or contraindicate the practice of exercise;
• have any major contraindications to exercise such as cardiomyopathy, cardiac arrhythmias and conduction abnormalities or congenital heart disease.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Rehabilitation Group; The rehabilitation Group will be submitted to an 8-week exercise and education program with a hybrid format, delivered by a professional physiotherapist at the Centre Jean-Jacques Gauthier (CJJG). Briefly, one in-person session (60 minutes of aerobic exercise and full-body strength exercise), one online session (30-35 minutes - focus on pelvic floor muscle training, core/abdominals, balance, and stretching exercises), and one pre-recorded video (30 minutes - exercise instructions) will be delivered per week. Participants will use Fitbit Charge-6 to progressively reach daily 10,000 steps throughout the intervention period. Four online educational workshops on healthy lifestyle will be delivered.	Other: Postpartum Cardio-obstetric Rehabilitation Program; The intervention consists of an 8-week exercise and education program with a hybrid format (in person, virtual and pre-recorded sessions). The aerobic exercise intensity will progressively increase from 50 to 85% of Targeted Heart Rate Range (THRR), calculated for middle-aged women using the maximal heart rate (HR) estimated as 206 - (0.88 x age) . First and second weeks training will target an intensity of 50-65% THRR, third and fourth weeks will target 65 to 75% of THRR, fifth to seventh weeks will target 75 to 80%, and eighth week will target 85%. Participants will use Fitbit Charge-6 to monitor THRR during exercise sessions. Pelvic floor, body alignment/core stability, balance, and low back pain prevention exercises will be added to each in-person session and repeated during the online session. Participants from the intervention group will receive recommendations to progressively reach daily 10,000 steps throughout the intervention period.
No Intervention: Control group; Control group participants will received the usual care, together with information about the guidelines for physical activity practice, nutritional and risk factor monitoring instructions, pelvic floor exercise instructions, and recommendations to progressively reach daily 10,000 steps according to guidelines . Participants will also receive a Fitbit device.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Office Blood Pressure	Resting office BP will be measured with the patient in the sitting position after 5 minutes at rest using a validated automated sphygmomanometer according to established practice guidelines . Three readings will be taken at intervals of 2 minutes.	Baseline, immediately post-intervention, and 6-month post-intervention
24-hour Ambulatory Blood Pressure	24-hour Ambulatory Blood Pressure using OSCAR 2 equipment.	Baseline, immediately post-intervention, and 6-month post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Static Retinal Vascular Analysis	Retinal microvasculature imaging will be taken using Static Vessel Analyzer (SVA-T, Imedos) through non-invasive procedures described by Hanssen's team .	Baseline, immediately post-intervention, and 6-month post-intervention
Peripheral artery stiffness - PWV	Peripheral artery stiffness will be measured using SphygmoCor XCEL system through pulse wave velocity (PWV) as described by Daskalopoulou's team.	Baseline, immediately post-intervention, and 6-month post-intervention
Peripheral artery stiffness - PWA	The Sphygmocor XCEL system will be used to assess arterial stiffness through Pulse Wave Analysis (PWA), according to the instruction guidelines.	Baseline, immediately post-intervention, and 6-month post-intervention
Physical capacity (6MWT)	Six-minute walk test will be performed following the protocol described by the American Thoracic Society.	Baseline, immediately post-intervention, and 6-month post-intervention
Physical activity levels	All participants will receive a wrist worn heart rate and accelerometer monitor (Fitbit Charge 6). This device will be used to monitor physical activity levels (total steps per week) and targeted heart rates during exercise training.	Baseline, immediately post-intervention, and 6-month post-intervention
Body composition	Body composition will be measure using a bioimpedance scale InBody 570.	Baseline, immediately post-intervention, and 6-month post-intervention
Timed Up and Go (TUG)	TUG test: The objective of TUG test is to assess mobility, balance and fall-risk. It consists of the participant stand-up from a chair, walk 3 meters, turn, walk back and sit down again. Interpretation: test performed ≤10 seconds indicates normal mobility.	Baseline, immediately post-intervention, and 6-month post-intervention
Handgrip strength	The maximal handgrip strength will be performed using a manual Jamar Hydraulic Hand Dynamometer.	Baseline, immediately post-intervention, and 6-month post-intervention
Glucose	Blood draw by venipuncture will be collected to measure glucose at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
Angiogenic and proliferative function of peripheral blood ECFCs	Endothelial cell function will be assessed by the procedures described by Bertagnolli's team . ECFCs = Endothelial colony forming cell	Baseline, immediately post-intervention, and 6-month post-intervention
Plasmatic levels of angiogenic factors - VEGF	Serum concentration of angiogenic factors by ELISA following manufacturer instructions - Vascular endothelial growth factor (VEGF)	Baseline, immediately post-intervention, and 6-month post-intervention
Heart rate variability	R-R intervals will be recorded using a Vantage V2 Polar heart rate monitor at a sampling rate of 1,000 Hz. HRV will be recorded during deep breathing maneuver (continuous cycles) for 4 min in a supine position. HRV will be analyzed using Kubios HRV software following guidelines from the Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.	Baseline, immediately post-intervention, and 6-month post-intervention
Circulating Endothelial Cells (cEC) Function	cEC tube formation capacity on matrigel, proliferation, and migration capacities.	Baseline, immediately post-intervention, and 6-month post-intervention
Total cholesterol	Blood draw by venipuncture will be collected to measure total cholesterol at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
Insuline	Blood draw by venipuncture will be collected to measure total cholesterol at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
Glycated hemoglobin (HbA1c)	Blood draw by venipuncture will be collected to measure HbA1c at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
LDL cholesterol	Blood draw by venipuncture will be collected to measure LDL-cholesterol at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
HDL cholesterol	Blood draw by venipuncture will be collected to measure HDL cholesterol at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
Triglycerides	Blood draw by venipuncture will be collected to measure triglycerides at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
Brain Natriuretic Peptide (NT-PRO-BNP)	Blood draw by venipuncture will be collected to measure NT-PRO-BNP at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
C-reactive protein (CRP)	Blood draw by venipuncture will be collected to measure C-reactive protein (CRP) at the Biochemistry laboratory of the MUHC.	Baseline, immediately post-intervention, and 6-month post-intervention
Plasmatic levels of angiogenic factors - NO	Serum concentration of angiogenic factors by ELISA following manufacturer instructions - Nitric Oxide (NO).	Baseline, immediately post-intervention, and 6-month post-intervention

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
SF-36 Quality of Life Questionnaire (SF-36).	Health status will be evaluated based on: SF-36 Quality of Life Questionnaire (SF-36).	Baseline, immediately post-intervention, and 6-month post-intervention
Patient Health Questionnaire-9 (PHQ-9)	Health status will be evaluated based on: Patient Health Questionnaire-9 (PHQ-9) for depression symptoms	Baseline, immediately post-intervention, and 6-month post-intervention
Edinburgh Postnatal Depression Scale (EPDS).	Health status will be evaluated based on: Edinburgh Postnatal Depression Scale (EPDS).	Baseline, immediately post-intervention, and 6-month post-intervention
Pittsburgh Sleep Quality Index (PSQI).	Health status will be evaluated based on: Pittsburgh Sleep Quality Index (PSQI).	Baseline, immediately post-intervention, and 6-month post-intervention
Pregnancy Physical Activity Questionnaire (PPAQ).	Physical activity will be also evaluated based on Pregnancy Physical Activity Questionnaire (PPAQ).	Baseline, immediately post-intervention, and 6-month post-intervention
Duke Activity Status Index (DASI)	Physical activity will be also evaluated based on Duke Activity Status Index (DASI)	Baseline, immediately post-intervention, and 6-month post-intervention
International Physical Activity Questionnaire (IPAQ).	Physical activity will be also evaluated based on International Physical Activity Questionnaire (IPAQ).	Baseline, immediately post-intervention, and 6-month post-intervention
Pelvic Floor Distress Inventory (PFDI-20)	Pelvic health will be evaluated by Pelvic Floor Distress Inventory (PFDI-20)	Baseline, immediately post-intervention, and 6-month post-intervention
Urogenital Distress Inventory (UDI)	Pelvic health will be evaluated by Urogenital Distress Inventory (UDI).	Baseline, immediately post-intervention, and 6-month post-intervention
Pelvic Floor Impact Questionnaire (PFIQ-7).	Pelvic health will be evaluated by Pelvic Floor Impact Questionnaire (PFIQ-7).	Baseline, immediately post-intervention, and 6-month post-intervention

Collaborators and Investigators

• Sponsor: Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal

Publications and helpful links

General Publications

• Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007 Nov 10;335(7627):974. doi: 10.1136/bmj.39335.385301.BE. Epub 2007 Nov 1.
• Visser VS, Hermes W, Franx A, Koopmans CM, van Pampus MG, Mol BW, de Groot CJ. High blood pressure six weeks postpartum after hypertensive pregnancy disorders at term is associated with chronic hypertension. Pregnancy Hypertens. 2013 Oct;3(4):242-7. doi: 10.1016/j.preghy.2013.07.002. Epub 2013 Aug 9.
• Phan K, Schiller I, Dendukuri N, Gomez YH, Gorgui J, El-Messidi A, Gagnon R, Daskalopoulou SS. A longitudinal analysis of arterial stiffness and wave reflection in preeclampsia: Identification of changepoints. Metabolism. 2021 Jul;120:154794. doi: 10.1016/j.metabol.2021.154794. Epub 2021 May 8.
• Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P; Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014 Apr;4(2):105-45. doi: 10.1016/j.preghy.2014.01.003. Epub 2014 Feb 25.
• Lampinen KH, Ronnback M, Kaaja RJ, Groop PH. Impaired vascular dilatation in women with a history of pre-eclampsia. J Hypertens. 2006 Apr;24(4):751-6. doi: 10.1097/01.hjh.0000217859.27864.19.
• Davenport MH, Ruchat SM, Mottola MF, Davies GA, Poitras VJ, Gray CE, Garcia AJ, Barrowman N, Adamo KB, Duggan M, Barakat R, Chilibeck P, Fleming K, Forte M, Korolnek J, Nagpal T, Slater LG, Stirling D, Zehr L. 2019 Canadian Guideline for Physical Activity Throughout Pregnancy: Methodology. J Obstet Gynaecol Can. 2018 Nov;40(11):1468-1483. doi: 10.1016/j.jogc.2018.09.004. Epub 2018 Oct 18. No abstract available.
• Bertagnolli M, Nuyt AM, Thebaud B, Luu TM. Endothelial Progenitor Cells as Prognostic Markers of Preterm Birth-Associated Complications. Stem Cells Transl Med. 2017 Jan;6(1):7-13. doi: 10.5966/sctm.2016-0085. Epub 2016 Jul 27.

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2025
• Primary Completion (Estimated): August 30, 2026
• Study Completion (Estimated): December 30, 2026

Study Registration Dates

• First Submitted: March 14, 2025
• First Submitted That Met QC Criteria: April 3, 2025
• First Posted (Actual): April 9, 2025

Study Record Updates

• Last Update Posted (Actual): May 14, 2025
• Last Update Submitted That Met QC Criteria: May 12, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Keywords: blood pressure; physical exercise; endothelial function; pre-eclampsia; gestational hypertension; Pelvic Floor; small vessels; postpartum rehabilitation
• Additional Relevant MeSH Terms: Urogenital Diseases; Vascular Diseases; Cardiovascular Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Pre-Eclampsia; Hypertension, Pregnancy-Induced; Hypertension
• Other Study ID Numbers: MP-32-2025-2963

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No