Abstract P100: Improving Ideal Cardiovascular Health in a Pediatric Preventive Cardiology Practice

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Holly C Gooding ◽  
Kimberlee Gauvreau ◽  
Jennifer Bachman ◽  
Annette Baker ◽  
Skylar Griggs ◽  
...  
Keyword(s):  
Cardiovascular Health ◽  
Dietary Habits ◽  
Smoking Status ◽  
Clinical Care ◽  
Pediatric Care ◽  
Initial Assessment ◽  
Ideal Cardiovascular Health ◽  
Preventive Cardiology ◽  
Cardiology Clinic

Introduction: Achieving ideal cardiovascular health (iCVH) for children necessitates both public health and individual interventions. Hypothesis: We hypothesized that children referred to a multidisciplinary preventive cardiology clinic would demonstrate improved iCVH after clinic-based lifestyle counseling. Methods: We analyzed data from youth ages 8-19 years seen for ≥2 consecutive visits in the Boston Children’s Hospital Preventive Cardiology clinic between 2010-2017. Demographic information, smoking status, diet, and physical activity were self-reported. Anthropometric data, blood pressure, fasting cholesterol, and fasting glucose were measured using standard protocols. We applied AHA definitions of ideal, intermediate, and poor iCVH with minor adaptations to data extracted from a clinical registry. Each iCVH metric had a possible range of 0 (poor) to 2 (ideal); the total iCVH score could range from 0 (all poor) to 14 (all ideal). Results: Median age of the 767 children in the study was 12.5 years [IQR 10.2,15.9]; 414 (54%) were female and 32 (5%) had a moderate or high CVD risk condition (diabetes, renal disease, Kawasaki, congenital heart disease, or heart transplant). Over a median of 3.9 [IQR 3.2, 6.0] months from initial assessment to first follow-up, mean iCVH score improved from 7.7 (SD 2.2) to 8.1 (SD 2.2) (p < 0.001). Females had higher iCVH scores at baseline and follow-up (females 7.9 to 8.4 vs. males 7.5 to 7.9, p<0.001), as did children younger than 14 years of age (data not shown). iCVH score improved to a mean of 8.3 (SD 2.4) for the 449 children returning for a third visit. The largest improvement was observed in total cholesterol and dietary habits (Figure); only 61 (8%) of children were prescribed statin therapy. Conclusion: Multidisciplinary clinical care can improve the iCVH of children who present with non-optimal levels, largely without the use of medications. Further work is needed to determine the scalability and long-term effectiveness of cardiovascular health promotion efforts in pediatric care.

Early Life Famine Exposure, Ideal Cardiovascular Health Metrics and Risk of Incident Diabetes: Findings from the 4C Study

2020 ◽  
Author(s):  
Jieli Lu ◽  
Mian Li ◽  
Yu Xu ◽  
Yufang Bi ◽  
Yingfen Qin ◽  
...  
Keyword(s):  
Cardiovascular Health ◽  
Dietary Habits ◽  
Ideal Cardiovascular Health ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Famine Exposure ◽  
Design And Methods ◽  
The Impact ◽  
Risk Ratios

<b>OBJECTIVE</b> <p>We aim to investigate the impact of ideal cardiovascular heath metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>This study included 77 925 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study, who were born around the time of the Chinese Great Famine and free of diabetes at baseline. They were divided into 3 famine exposure groups according to the birth year, including non-exposed (1963-1974), fetal-exposed (1959-1962) and childhood exposed (1949-1958). Relative risk regression was used to examine the associations between famine exposure and ICVHMs on diabetes.</p> <p><b>RESULTS</b></p> <p>During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0% and 7.5% in non-exposed, fetal-exposed and childhood-exposed participants, respectively. Compared with non-exposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes with multivariable-adjusted risk ratios (RRs) (95% confidence intervals) (CIs) of 1.17 (1.05-1.31) and 1.12 (0.96-1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals with non-ideal dietary habits, non-ideal physical activity, BMI ≥24.0 kg/m<sup>2</sup>, or blood pressure ≥120/80 mmHg, whereas significant interaction was detected only in BMI strata (P for interaction=0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes (P for interaction=0.0005). The increased risk was observed in fetal-exposed participants with 1 or less ICVHMs (RR, 1.59; 95% CI, 1.24-2.04), but not in those with 2 or more ICVHMs. </p> <p><b>CONCLUSIONS</b></p> <p>The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs. </p>

scholarly journals Early Life Famine Exposure, Ideal Cardiovascular Health Metrics and Risk of Incident Diabetes: Findings from the 4C Study

2020 ◽  
Author(s):  
Jieli Lu ◽  
Mian Li ◽  
Yu Xu ◽  
Yufang Bi ◽  
Yingfen Qin ◽  
...  
Keyword(s):  
Cardiovascular Health ◽  
Dietary Habits ◽  
Ideal Cardiovascular Health ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Famine Exposure ◽  
Design And Methods ◽  
The Impact ◽  
Risk Ratios

<b>OBJECTIVE</b> <p>We aim to investigate the impact of ideal cardiovascular heath metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>This study included 77 925 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study, who were born around the time of the Chinese Great Famine and free of diabetes at baseline. They were divided into 3 famine exposure groups according to the birth year, including non-exposed (1963-1974), fetal-exposed (1959-1962) and childhood exposed (1949-1958). Relative risk regression was used to examine the associations between famine exposure and ICVHMs on diabetes.</p> <p><b>RESULTS</b></p> <p>During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0% and 7.5% in non-exposed, fetal-exposed and childhood-exposed participants, respectively. Compared with non-exposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes with multivariable-adjusted risk ratios (RRs) (95% confidence intervals) (CIs) of 1.17 (1.05-1.31) and 1.12 (0.96-1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals with non-ideal dietary habits, non-ideal physical activity, BMI ≥24.0 kg/m<sup>2</sup>, or blood pressure ≥120/80 mmHg, whereas significant interaction was detected only in BMI strata (P for interaction=0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes (P for interaction=0.0005). The increased risk was observed in fetal-exposed participants with 1 or less ICVHMs (RR, 1.59; 95% CI, 1.24-2.04), but not in those with 2 or more ICVHMs. </p> <p><b>CONCLUSIONS</b></p> <p>The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs. </p>

Abstract 021: Higher Levels of Ideal Cardiovascular Health Are Associated With Lower Risk of Incident Type 2 Diabetes Mellitus Among Individuals With Normal Fasting Glucose but Not Impaired Fasting Glucose: The Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Joshua J Joseph ◽  
Aleena Bennett ◽  
Justin B Echouffo Tcheugui ◽  
Valery S Effoe ◽  
James Odei ◽  
...  
Keyword(s):  
Racial Differences ◽  
Impaired Fasting Glucose ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Fasting Glucose ◽  
Glycemic Status ◽  
Ideal Cardiovascular Health ◽  
Normal Fasting Glucose ◽  
Prevention Of Diabetes

Aims/hypothesis: Ideal cardiovascular health (ICH) is associated with lower risk of incident diabetes, but whether this association varies by baseline glycemia (normal [<100 mg/dL] vs. impaired fasting glucose [100-125 mg/dL]) remains to be clarified. We assessed the incidence of diabetes based on American Heart Association (AHA) ICH components stratified by glycemic status to determine whether ICH is more effective for primordial or primary prevention of diabetes among middle-aged and older adults. Methods: This study included 7,662 non-Hispanic whites and African Americans from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study without prevalent diabetes at baseline (2003-2006), who completed the follow-up exam (2013-2016). Participants were categorized as having ideal, intermediate or poor cardiovascular health, as defined by the AHA 2020 Impact Goals, based on baseline ICH components (total cholesterol, blood pressure, dietary intake, tobacco use, physical activity and body-mass index (BMI)). We categorized participants based on their total number of components that were ideal (0-1 “poor”, 2-3 “intermediate”, and 4+ “ideal”). Incident rate ratios (IRR) were calculated using modified poisson regression adjusting for age, sex, education, income, race, alcohol use, estimated glomerular filtration rate, urine albumin:creatinine ratio and high-sensitivity C-reactive protein. After confirming significant interactions with multiplicative interaction terms and application of likelihood ratio test, we stratified by glycemic status (normal vs. impaired fasting glucose). Results: Among REGARDS participants (mean age 63.0 [SD 8.4] years, 56% female, 26% African American), there were 560 incident diabetes cases (median follow-up 9.5 years). Overall, those with 2-3 and 4+ ICH components vs. 0-1 components had 31% (IRR 0.69; 95% CI 0.61, 0.79) and 71% lower (IRR 0.29; 95% CI 0.20, 0.42) risk of diabetes, respectively. Among 5,930 participants with normal fasting glucose, these risks were 36% (IRR 0.64; 95% CI 0.52, 0.79) and 80% lower (IRR 0.20; 95% CI 0.10, 0.37), while among 1,732 participants with baseline impaired fasting glucose these risks were 8% (IRR 0.92; 95% CI 0.80,1.07) and 13% lower (IRR 0.87; 95% CI 0.58,1.30) (p for interaction by baseline glucose status <0.0001). Conclusions/interpretation: Meeting an increasing number of ideal levels of dietary intake, physical activity, smoking, blood pressure, cholesterol and BMI was associated with a dose-dependent lower risk of diabetes for individuals with normal fasting glucose but not impaired fasting glucose. This suggests the AHA 2020 guidelines may be more effective for primordial versus primary prevention of diabetes among middle-aged and older adults.

The Association of Cardiorespiratory Fitness and Ideal Cardiovascular Health in the Aerobics Center Longitudinal Study

2019 ◽  
Vol 16 (11) ◽  
pp. 968-975
Author(s):  
Leanna M. Ross ◽  
Jacob L. Barber ◽  
Alexander C. McLain ◽  
R. Glenn Weaver ◽  
Xuemei Sui ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Cardiorespiratory Fitness ◽  
Mixed Models ◽  
Cardiovascular Health ◽  
Cross Sectional ◽  
Ideal Cardiovascular Health ◽  
The Poor ◽  
Longitudinal Associations ◽  
Aerobics Center Longitudinal Study

Background: This study examined the cross-sectional and longitudinal associations of cardiorespiratory fitness (CRF) and ideal cardiovascular health (CVH). Methods: CRF and the 7 CVH components were measured in 11,590 (8865 males; 2725 females) adults at baseline and in 2532 (2160 males; 372 females) adults with at least one follow-up examination from the Aerobics Center Longitudinal Study. Ideal CVH score was calculated as a composite of 7 measures, each scored 0 to 2. CVH groups were based on participant point score: ≤7 (poor), 8 to 11 (intermediate), and 12 to 14 (ideal). Analyses included general linear, logistic regression, and linear mixed models. Results: At baseline, participants in the high CRF category had 21% and 45% higher mean CVH scores than those in the moderate and poor CRF categories (P < .001). The adjusted odds (95% confidence interval) of being in the poor CVH group at baseline were 4.9 (4.4–5.4) and 16.9 (14.3–19.9) times greater for individuals with moderate and low CRF, respectively, compared with those with high CRF (P < .001). Longitudinal analysis found that for every 1-minute increase in treadmill time, CVH score increased by 0.23 units (P < .001) independent of age, sex, exam number, and exam year. Conclusions: Higher CRF is associated with better CVH profiles, and improving CRF over time is independently associated with greater improvements in CVH.

Evaluating the sensitivity of the ACC/AHA pooled cohort risk calculator to predict atherosclerotic cardiovascular events within 10 years: how many events are we failing to predict?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Medina-Inojosa ◽  
V.K Somers ◽  
S Hayes ◽  
R Mankad ◽  
F Lopez-Jimenez
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Health ◽  
Fasting Blood Glucose ◽  
Low Risk ◽  
P Value ◽  
Funding Source ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ideal Cardiovascular Health ◽  
Ascvd Risk

Abstract Background The ACC/AHA Pooled Cohort Equation (PCE) for atherosclerotic cardiovascular disease (ASCVD) has been recommended as the initial step in cardiovascular risk assessment. The sensitivity of this tool to detect those who will develop ASCVD within 10-years, while considering age and sex groups, has not been extensively studied. Methods Using the Rochester Epidemiology Project (REP) we evaluated a community-based cohort of consecutive patients that sought primary care in Olmsted County, MN, between the years 1998–2000 and were followed up through March 1st 2016. Inclusion criteria were ages 40–79 and complete data to calculate the PCE. We excluded those with known ASCVD, atrial fibrillation or heart failure. Criteria were similar to those used to derive the PCE. Events were validated in duplicate and included fatal and non-fatal myocardial infarction and ischemic stroke. Patient information was ascertained using the record linkage system of the REP. Follow-up was truncated at 10 years. We assessed the ASCVD predicted risk (categorized as low &lt;5%, intermediate 5–9.9%, high 10–19.9%, and very high ≥20% risk) at baseline, in subjects having an ASCVD event within 10-years in the community across age (&lt;65 years) and sex categories. We also categorized ideal cardiovascular health as ≥4 metrics [non-smoker, body mass index &lt;25 kg/m2, and not having of elevated blood pressure (≥130/80 mmHg), LDL cholesterol (&gt;100 mg/dL), or fasting blood glucose (&gt;100 mg/dL), in the absence of a medical diagnosis or treatment]. Results We included 30,042 adults, mean ± SD age 48.5±12.2 years, 54% women, with a median follow-up of 16.5±5.3 years. There were 1,555 ASCVD events (5.2%) at 10 years of follow-up. The performance of the PCE was similar to what was described in the original report (0.78 vs 0.79). Overall, among those who suffered an ASCVD, 54% of women and 41% of men were not high risk as predicted by PCE (Figure 1A). Most women (73%) &lt;65 years of age would had been considered low risk within 10-years before the event, and only 10% would have been considered to be high risks (Figure 1B). Nonetheless, women &lt;65 years who had an ASCVD event and low 10-year predicted ASCVD risk by PCE were less likely to have ideal cardiovascular health [55 (0.40%) vs 3884 (28.39%), p-value&lt;0.0001], when compared to women in the low risk category without an event. Conclusion The PCE fails to identify most women who will develop an ASCVD event, particularly women &lt;65 years of age. These results underscore the importance of using additional information when estimating ASCVD risk among women and the need for better cardiovascular risk prediction tools. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Mayo Clinic

Abstract P216: Prevalence of Life’s Simple Seven Cardiovascular Health Metrics in the Million Veteran Program

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Xuan-Mai T Nguyen ◽  
Rachel M Quaden ◽  
Rebecca J Song ◽  
Yuk-Lam Ho ◽  
Kelly Cho ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Total Cholesterol ◽  
Plasma Glucose ◽  
Cardiovascular Health ◽  
Smoking Status ◽  
Dietary Factors ◽  
Cross Sectional ◽  
Ideal Cardiovascular Health ◽  
Us Veterans

Background: While previous studies have reported the prevalence of Life’s Simple Seven (LSS) in the general population, no data exist in a national sample of US veterans. Objective: To assess the prevalence of ideal LSS in a cross-sectional study of 500,000 US Veterans participating in the Million Veteran Program (MVP) from 2011-2016. Methods: We assigned one of three possible values (0=poor, 1=intermediate, 2=ideal) for each of the seven LSS metrics (adiposity /BMI), smoking status, total cholesterol, blood pressure, plasma glucose, diet, physical activity) at baseline using self-reported data and electronic health records. A total score of 0 across all seven metrics indicated overall poor cardiovascular health and a score of 14 indicated ideal cardiovascular health. Results: Complete data on all LSS factors were available for 171,146 Veterans (92% men and mean age 65.5yrs ±11.5 SD). Average LSS score was 6.1 ±1.9. Ideal BMI, smoking status, total cholesterol, blood pressure and plasma glucose (fasting and non-fasting) was present in 23.8%, 30%, 22.2%, 22.5% and 42.9%, respectively, in the study population (Fig). Prevalence of ideal diet was 0.4%. Among dietary factors, recommendation for fruits and vegetables (at least 4.5cups/day) was the least likely to be achieved. Physical activity at the workplace, home or at leisure was reported among 25.6% of Veterans (21.8% intermediate and 3.8% ideal physical activity). Conclusions: Our data show a low prevalence of ideal LSS among Veterans in the MVP, especially diet (0.4%) and physical activity (3.8%). Compared to NHANES 2005-2006 unadjusted prevalence estimates for AHA 2020 goals, Veterans in MVP have a lower prevalence of all ideal LSS metrics except for diet: BMI (23.8 vs 33%), physical activity (3.8 vs 45%), smoking status (30 vs 73%), total cholesterol (22.2 vs 45%) blood pressure (22.5 vs 42%) and glucose (42.9 vs 58%). These findings underscore the need to improve adherence to modifiable lifestyle factors with subsequent reduction in CVD burden among Veterans.

Abstract P114: Low Prevalence of Ideal Cardiovascular Health Metrics among African Americans: The Jackson Heart Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Luc Djousse ◽  
Andrew Petrone ◽  
Chad Blackshear ◽  
Michael Griswold ◽  
Jane Harman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
African Americans ◽  
Cardiovascular Health ◽  
Smoking Status ◽  
Jackson Heart Study ◽  
Men And Women ◽  
Ideal Cardiovascular Health ◽  
Heart Study

Background: While the prevalence of cardiovascular health metrics or Life’s Simple Seven (LSS) has been shown to be far from optimal in the US, such information has been predominantly reported in Caucasians. The burden of cardiovascular disease among African Americans underscores the need to evaluate the prevalence and secular trends of LSS in other ethnic groups. Objective: To test the hypothesis that the prevalence of the LSS is far from ideal among participants of the Jackson Heart Study. Methods: We analyzed LSS with 3,500 African Americans from the Jackson Heart Study, using data from their first clinic visit (2000-2004). Standard methods were used to measure blood pressure, glucose, body mass index (BMI), and cholesterol. Information on physical activity, smoking, and diet was collected with interviewer-administered questionnaires. Each of the LSS metrics (smoking status, diet, physical activity, BMI, fasting blood glucose, total cholesterol, and blood pressure) was categorized as poor, intermediate, or ideal, as defined by the AHA guidelines. Results: The mean age at baseline was 56.9 ± 12.2 years and 2,350 participants (67%) were women. Among men, the prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal cardiovascular health metrics was 6.6%, 25.8%, 32.7%, 21.6%, 10.6%, 2.3%, 0.4%, and 0%, respectively. Corresponding values for women were 3.2%, 28.1%, 32.9%, 22.3%, 10.1%, 2.9%, 0.38%, and 0%. While about two-thirds of men and women reported ideal smoking status, almost none reported ideal diet quality, and few met recommendations for BMI and blood pressure ( Figure) . Conclusions: Our data are consistent with less than optimal prevalence of cardiovascular health metrics in both men and women from the Jackson Heart Study. The lower prevalence of meeting ideal recommendations for diet, physical activity, BMI, and blood pressure underscores the need for targeted interventions to improve these modifiable lifestyle factors in order to reduce the burden of cardiovascular disease among African-Americans.

Abstract 37: The Association of Cardiorespiratory Fitness and Ideal Cardiovascular Health in the Aerobics Center Longitudinal Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Leanna M Ross ◽  
Jacob L Barber ◽  
Xuemei Sui ◽  
Steven N Blair ◽  
Mark A Sarzynski
Keyword(s):  
Longitudinal Study ◽  
Cardiorespiratory Fitness ◽  
Cardiovascular Health ◽  
Smoking Status ◽  
Cross Sectional ◽  
Ideal Cardiovascular Health ◽  
Logistic Regression Models ◽  
Using Data ◽  
Middle Aged Adults ◽  
Aerobics Center Longitudinal Study

Purpose: To examine the cross-sectional association between cardiorespiratory fitness (CRF) and ideal cardiovascular health (CVH) in middle-aged adults. Methods: The association between CRF and ideal CVH score was examined in 11,590 adults (8,865 men, 2,725 women) from the Aerobics Center Longitudinal Study. CRF was measured as duration in minutes from a maximal treadmill test. The AHA’s ideal CVH score was calculated on a 14 point scale using data on smoking status, BMI, physical activity (MET-min/wk), healthy diet, total cholesterol, blood pressure, and fasting plasma glucose recorded between 1987 and 1999. Participants were grouped into categories of inadequate (0-4), average (5-9), and optimum (10-14) based on their CVH score. Three CRF groups were created from age- and sex-specific quintiles based on the previously established cutpoints of treadmill time: low, moderate, and high CRF. We used general linear and logistic regression models adjusted for age, sex, and year of examination to evaluate the association of CRF with ideal CVH score. Results: The mean CVH score for men was 8.4 ± 2.2 and 9.7 ± 2.0 for women. Approximately 33% of men and 57% of women had optimum CVH, while only a small proportion of participants had inadequate CVH (5.1% M, 1.4% F). Treadmill time was moderately correlated (p<0.0001) with CVH score in both men (r=0.56) and women (r=0.50). CRF explained 16% and sex 18% of the variance in CVH score (both p<0.0001). Our adjusted model found that participants in the optimum CVH category had 20% and 43% higher CRF levels than those in the average and inadequate CVH groups (p<0.0001), respectively ( Figure 1 ). The adjusted odds (95% CI) of having optimum CVH were 14.0 (11.0-17.8) and 3.1 (2.4-4.0) times greater for high CRF and moderate CRF, respectively, compared to low CRF (p<0.0001). Discussion: Higher levels of cardiorespiratory fitness are associated with better cardiovascular health profiles in both men and women. Thus, improving fitness represents a strategy to improve cardiovascular and public health.

Screening and Treatment for Depression During Pregnancy: A Cautionary Note

2005 ◽  
Vol 39 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Frances A Carter ◽  
Janet D Carter ◽  
Suzanne E Luty ◽  
Deborah A Wilson ◽  
Christopher M. A. Frampton ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Clinical Care ◽  
Depression Scale ◽  
Recruitment Strategy ◽  
Initial Assessment ◽  
Behaviour Therapy ◽  
Low Mood ◽  
Randomized Controlled ◽  
Cognitive Behaviour

Objective: The aim of this study was to evaluate the recruitment and retention of depressed pregnant women, identified initially through screening, to a randomized controlled psychotherapy trial. Method: Consecutive pregnant women presenting for routine ultrasound scan were asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Women who scored greater than 12 on the EPDS and who agreed to contact were invited to attend an initial assessment to determine eligibility for the trial. Consenting, eligible women were randomized to either cognitive behaviour therapy (CBT) or routine clinical care (RCC). Follow-up assessments were conducted at mid (6 weeks following initial assessment), end (approximately 36 weeks gestation), and postpartum (approximately 4 months postdelivery) for all participants. Results: 400 women were offered the EPDS, and 93% completed the questionnaire (370/400). Thirteen percent (49/370) of these women scored greater than 12, although only a minority of these women agree to be contacted (15/49). Of those who agreed to be contacted, less than half attended initial interview (7/15 attended; 3/15 ineligible; 5/15 declined). Upon interview, all women except for one, were eligible and consenting (6/7). Three women were randomized to CBT and three to RCC. Only one woman randomized to CBT chose to commence treatment, and only one woman randomized to RCC was offered treatment for her low mood by her lead maternity provider. Conclusions: While the vast majority of pregnant women were willing to complete a depression screening questionnaire, most did not agree to additional contact or assessment, and either were not offered treatment or did not accept treatment. This was not an effective recruitment strategy for a randomized controlled psychotherapy trial.

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