Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

Background: The American College of Obstetricians and Gynecologists and the American Heart Association recommend that women with hypertensive disorders of pregnancy be counseled on lifelong cardiovascular risks and transitioned to primary care for ongoing screening and management. Objective: To assess frequency and content of postpartum counseling regarding cardiovascular risk and follow-up among women with hypertensive disorders of pregnancy. Study Design: A secondary analysis of a randomized trial of women with hypertensive disorders of pregnancy, excluding chronic hypertension, performed at a single tertiary care academic hospital. We abstracted documented counseling on hypertensive disorders from the discharge summary and postpartum visit note in the electronic medical record. We defined counseling as documentation of any one of the following: 1) recommending aspirin in a future pregnancy, 2) follow-up with primary care, or 3) lifelong risk of cardiovascular disease. We used logistic regression models to estimate adjusted odds for receiving counseling. Results: Seventy-four women enrolled in the study. A hypertensive diagnosis was documented for 71 women (96.0%) in the discharge summary, but only 11 (14.9%) had any documented counseling in the discharge summary or postpartum visit note. Of the 11 women counseled, 5 (6.7%) were counseled on taking aspirin in a future pregnancy, 5 (6.7%) were counseled on follow-up with primary care, and only 3 (4.1%) were counseled on the lifelong cardiovascular risk associated with hypertension in pregnancy. Two women (2.7%) were counseled on follow-up with primary care and lifelong cardiovascular risk. There were no participants counseled on all three components. Later gestational age at delivery was associated with lower odds of counseling (adjusted OR 0.49, 95% CI 0.27-0.89). Conclusion: Despite consistent evidence on long-term risks of hypertensive disorders of pregnancy, counseling about those risks is suboptimal. Improved communication of risks is the first step towards improving maternal health in the “fourth trimester” and beyond.

Download Full-text

Assessing knowledge of healthcare providers concerning cardiovascular risk after hypertensive disorders of pregnancy: an Australian national survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03418-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Heike Roth ◽

Caroline S. E. Homer ◽

Clare Arnott ◽

Lynne Roberts ◽

Mark Brown ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Health ◽

Gestational Hypertension ◽

Current Knowledge ◽

Healthcare Providers ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Increased Risk

Abstract Background Hypertensive disorders of pregnancy (HDP) affect 5–10% of pregnant women. Women after HDP have 2–3 times increased risk of heart attack, stroke and diabetes, as soon as 5–10 years after pregnancy. Australian healthcare providers’ knowledge of cardiovascular disease (CVD) risks for women after HDP is unknown, and this study aimed to explore their current knowledge and practice regarding long-term cardiovascular health after HDP, as a precursor to producing targeted healthcare provider education on health after HDP. Methods A custom-created, face-validated online survey explored knowledge about long-term risks after HDP. Distribution occurred from February to July 2019 via professional colleges, key organisations and social media. The objective was to assess current knowledge and knowledge gaps amongst a group of healthcare providers (HCP) in Australia, regarding long-term cardiovascular health after hypertensive disorders of pregnancy (HDP), specifically gestational hypertension or preeclampsia. Results Of 492 respondents, 203 were midwives, 188 obstetricians, 75 general practitioners (GP), and 26 cardiologists. A risk knowledge score was computed with 0–6 considered low, 6.1–8.9 moderate and 9–12 high. Most participants (85%) were aware of increased cardiovascular disease after preeclampsia and gestational hypertension (range 76% midwives to 100% cardiologists). There were significant differences in average knowledge scores regarding health after preeclampsia; high for cardiologists (9.3), moderate for GPs and obstetricians (8.2 and 7.6 respectively) and low for midwives (5.9). Average knowledge scores were somewhat lower for gestational hypertension (9.0 for cardiologists, 7.4 for obstetricians and GPs, 5.1 for midwives). Knowledge was highest regarding risk of chronic hypertension, moderate to high regarding risk of ischaemic heart disease, stroke and recurring HDP, and low for diabetes and peripheral vascular disease. Only 34% were aware that risks start < 10 years after the affected pregnancy. Conclusion(s) Participants were aware there is increased cardiovascular risk after HDP, although less aware of risks after gestational hypertension and some specific risks including diabetes. Findings will inform the development of targeted education.

Download Full-text

Faculty Opinions recommendation of Hypertensive Disorders of Pregnancy and 10-Year Cardiovascular Risk Prediction.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733991937.793551013 ◽

2018 ◽

Author(s):

Wilbert Aronow

Keyword(s):

Cardiovascular Risk ◽

Risk Prediction ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Cardiovascular Risk Prediction

Download Full-text

OP 10 Longitudinal assessment of cardiovascular risk factors after hypertensive disorders of pregnancy – Towards identifying a window of opportunity for screening and prevention

Pregnancy Hypertension ◽

10.1016/j.preghy.2017.07.033 ◽

2017 ◽

Vol 9 ◽

pp. 13-14

Author(s):

Katrien Groenhof ◽

Gerbrand Zoet ◽

Arie Franx ◽

Ron Gansevoort ◽

Henk Groen ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Window Of Opportunity ◽

Longitudinal Assessment ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Screening And Prevention

Download Full-text

Long-Term Cardiovascular Disease Risk in Women After Hypertensive Disorders of Pregnancy: Recent Advances in Hypertension

Hypertension ◽

10.1161/hypertensionaha.121.16506 ◽

2021 ◽

Author(s):

Kavia Khosla ◽

Sarah Heimberger ◽

Kristin M. Nieman ◽

Avery Tung ◽

Sajid Shahul ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Risk Reduction ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Hypertensive Disorders Of Pregnancy ◽

Cardiovascular Risk Reduction ◽

Hypertensive Disorders ◽

History Of

Patients with a history of hypertensive disorders of pregnancy (HDP) suffer higher rates of long-term cardiovascular events including heart failure, coronary artery disease, and stroke. Cardiovascular changes during pregnancy can act as a natural stress test, subsequently unmasking latent cardiovascular disease in the form of HDP. Because HDP now affect 10% of pregnancies in the United States, the American Heart Association has called for physicians who provide peripartum care to promote early identification and cardiovascular risk reduction. In this review, we discuss the epidemiology, pathophysiology, and outcomes of HDP-associated cardiovascular disease. In addition, we propose a multi-pronged approach to support cardiovascular risk reduction for women with a history of HDP. Additional research is warranted to define appropriate blood pressure targets in the postpartum period, optimize the use of pregnancy history in risk stratification tools, and clarify the effectiveness of preventive interventions. The highest rates of HDP are in populations with poor access to resources and quality health care, making it a major risk for inequity of care. Interventions to decrease long-term cardiovascular disease risk in women following HDP must also target disparity reduction.

Download Full-text