Lifestyle interventions addressing cardiometabolic health among Black American women of reproductive age in the U.S. : an integrative review

BACKGROUND: Cardiometabolic disorders among childbearing women, particularly Black American women, contribute to adverse perinatal outcomes and long-term health consequences. Lifestyle interventions are critical approaches to improve cardiometabolic health. OBJECTIVE: This integrative review synthesized evidence on lifestyle interventions promoting cardiometabolic health among Black women of childbearing age in the U.S. METHODS: A comprehensive search strategy was developed and applied across PubMed, CINAHL, the Web of Science Core Collection, and Scopus from the databases' inception through August 2023. Key inclusion criteria were Black American women of childbearing age, lifestyle interventions using an experimental/quasi-experimental design conducted in the U.S., and cardiometabolic, health behavior, or psychosocial outcomes. RESULTS: Thirty-three studies were included, with 29 (87%) using randomized controlled trials. Lifestyle interventions were primarily implemented during pregnancy and/or postpartum periods, only two in pre-pregnancy stage. Health education (i.e. structured/unstructured teaching on various lifestyle content) was the main intervention component. While many studies incorporated digital health technologies, only six leveraged mhealth tools (e.g., mobile health applications, internet-based platforms, social media) as the primary delivery method. Weight change was the most common cardiometabolic outcome, with five out of 13 studies showing significant reductions in gestational weight gain or postpartum weight retention. Of seven studies measuring other cardiometabolic outcomes (e.g., blood glucose), only one showed a significantly decreased incidence of hypertension. Three of 11 studies reported a significant increase in physical activity, and four out of ten showed significant improvement in dietary behaviors. Nine of the 15 studies measuring psychosocial outcomes found significant improvement, with five noting decreased depression. Common weaknesses included recruitment challenges, convenience sampling, small sample sizes, high attrition rates, and short post-intervention follow-up. Some studies adopting digital health technologies reported better retention rates and higher engagement. CONCLUSIONS: The results suggest the potential impact of lifestyle interventions on weight reduction, increased physical activity, healthier dietary behaviors, and decreased depression. Future high-quality and powered studies are needed to investigate the efficacy of lifestyle interventions on cardiometabolic outcomes in this population by considering the use of digital health technologies to improve intervention recruitment, engagement and retention, including Black American women of childbearing age representing all socioeconomic levels, and targeting the pre-pregnancy stage.