Healthy lifestyle in high risk women
Evidence & Translation
Developing lifestyle management programs for infertility, PCOS or high-risk pregnancy.
Lifestyle programs for women with PCOS and infertility
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women. PCOS is associated with reproductive (menstrual irregularity, infertility and pregnancy complications), metabolic (metabolic syndrome, type 2 diabetes and cardiovascular disease) and psychological (anxiety and depression) co-morbidities. Lifestyle management (diet, physical activity and behavioural advice) for weight gain prevention or weight loss is the first-line treatment for PCOS according to NHMRC-approved guidelines. Infertility is a worldwide problem, affecting 10–15% of all couples. Couples who experience difficulty conceiving may also seek assisted reproductive technologies, such as in vitro fertilisation. Multiple factors, including lifestyle, can contribute to infertility in women and in men. It is crucial to both determine appropriate lifestyle management to improve fertility outcomes and how to best achieve these lifestyle changes in real world settings. The We engage with women, medical and allied health professionals and NGO stakeholders to assess efficacy and effectiveness of different modalities, delivery methods and intensities of lifestyle intervention for women with PCOS or women with infertility.
- Development of digital models of care for lifestyle management of PCOS or infertility
- Development of public and private health systems models of care for lifestyle management of PCOS or infertility
- Improving referral to and relevance and efficacy of community lifestyle programs for women with PCOS
- Assessment of different components of lifestyle including sleep and sitting time
- Assessing barriers and enablers to achieving lifestyle change for women with PCOS or infertility and health professionals working with women with PCOS and infertility to aid co-design of future interventions to improve efficacy
- Assessing mechanistic barriers to weight management and lifestyle change in PCOS including appetite regulation and energy expenditure
- Improving engagement with novel lifestyle messaging in PCOS
- Epidemiological research assessing research questions including health care utilisation, lifestyle practices and relationship between lifestyle and psychological or cardiometabolic health and screening in PCOS
Lifestyle programs for high risk pregnancy
We engage women, multidisciplinary researchers and health professionals and stakeholders from health services, community and government in a multi-step research program to co-design approaches and tools for screening, recall and lifestyle management, and in the implementation and evaluation activities.
During pregnancy, women can develop certain conditions, which can indicate that they have a higher risk of heart disease later in life. These include gestational diabetes, gestational hypertension or pre-eclampsia, spontaneous pre-term birth, intrauterine growth restriction of their fetus or gaining too much weight during pregnancy. Combined, these conditions can affect a third to up to a half of all pregnant women.
The recommended treatment for all of these conditions is lifestyle management including aiming for optimal diet and physical activity. The earlier women receive this treatment then the lower the risk of these conditions will be and the lower their risk of both a complicated pregnancy and heart disease following pregnancy.
By understanding how to identify women at high risk of pregnancy complications that contribute to a higher risk of heart disease after pregnancy, will to allow us to work with women earlier in pregnancy to optimise lifestyle.
We work to adapt existing programs for optimising diet and physical activity, and preventing weight gain during and following pregnancy, so that the programs reflect the needs of women.
Implementation and Impact
We work to find practical solutions for targeted screening, prevention and treatment opportunities, which can be incorporated into the existing healthcare system, to reduce the risk of heart disease in women.
- Development, validation and evaluation of risk prediction models for gestational diabetes and hypertensive disorders of pregnancy with clinical digital interface based on MH BOS routinely collected data.
- Modification and co-design of antenatal lifestyle programs to increase relevance to cardiometabolic conditions during pregnancy
- Development of implementation and evaluation plans for modified pilot lifestyle interventions for cardiometabolic conditions during pregnancy comprising elements of digital and remote health
- Establish a comprehensive clinical, biological and ultrasound biobank to identify phenotypes of women during pregnancy at highest cardio-metabolic risk requiring long-term follow-up.
- Expanding the National GDM Register to link in women with other high-risk phenotypes of cardio-metabolic complications during pregnancy
- Expanding community-based lifestyle management programs for postpartum women to include high-risk pregnancy categories.
- Implementation trial – evaluation of the effectiveness of the modified Registry
- Grieger JA, Hutchesson M, Cooray SD, Khomami MB, Zaman S, Segan L, Teede H, Moran LJ. A review of maternal overweight and obesity and its impact on cardiometabolic outcomes during pregnancy and postpartum. Ther Adv Reprod Health. 2021.15
- Thong EP, Ghelani D, Manoleehakul P, Yesmin A, Slater K, Taylor R, Collins C, Hutchesson M, Lim L, Teede H, Harrison CL, Moran LJ, Enticott J. Optimising cardio-metabolic risk factors in pregnancy: a review of risk prediction models targeting gestational diabetes and hypertensive disorders. J. Cardiovasc. Dev. Dis. 2021. .
We gratefully acknowledge the funding given to our group by the Heart Foundation of Australia.