scholarly journals Patterns of Postpartum Ambulatory Care Follow‐up Care Among Women With Hypertensive Disorders of Pregnancy

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Jennifer Lewey ◽  
Lisa D. Levine ◽  
Lin Yang ◽  
Jourdan E. Triebwasser ◽  
Peter W. Groeneveld
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Gestational Hypertension ◽  
Multivariable Analysis ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Increased Risk

Background Preeclampsia and gestational hypertension are hypertensive disorders of pregnancy (HDP) that identify an increased risk of developing chronic hypertension and cardiovascular disease later in life. Postpartum follow‐up may facilitate early screening and treatment of cardiovascular risk factors. Our objective is to describe patterns of postpartum visits with primary care and women's health providers (eg, family medicine and obstetrics) among women with and without HDP in a nationally representative sample of commercially insured women. Methods and Results We conducted a retrospective cohort study using insurance claims from a US health insurance database to describe patterns in office visits in the 6 months after delivery. We identified 566 059 women with completed pregnancies between 2005 and 2014. At 6 months, 13% of women with normotensive pregnancies, 18% with HDP, and 23% with chronic hypertension had primary care visits ( P <0.0001 for comparing HDP and chronic hypertension groups with control participants). Only 58% of women with HDP had 6‐month follow‐up with any continuity provider compared with 47% of women without hypertension ( P <0.0001). In multivariable analysis, women with severe preeclampsia were 16% more likely to have postpartum continuity follow‐up (adjusted odds ratio, 1.16; 95% CI, 1.2–1.21). Factors associated with a lower likelihood of any follow‐up included age ≥30 years, Black race, Hispanic ethnicity, and having multiple gestations. Conclusions Rates of continuity care follow‐up after a pregnancy complicated by hypertension were low. This represents a substantial missed opportunity to provide cardiovascular risk screening and management to women at increased risk of future cardiovascular disease.

scholarly journals Evaluation of Postpartum Counseling on Future Health Risks Associated with Hypertensive Disorders of Pregnancy

2020 ◽  
pp. 1-5
Author(s):  
Jourdie Triebwasser ◽  
Elizabeth S. Langen ◽  
Jennifer Lewey ◽  
Jourdie Triebwasser
Keyword(s):  
Primary Care ◽  
Cardiovascular Risk ◽  
Tertiary Care ◽  
Discharge Summary ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Postpartum Visit ◽  
Hypertensive Disorders ◽  
Future Pregnancy

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.

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

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.

scholarly journals Association between hypertensive disorders of pregnancy and cardiovascular disease in a population of Cameroonian women at two hospitals of yaounde : a case control study

2018 ◽  
Author(s):  
Benedict Taa Nguimbis Esseme ◽  
Mbondji Ebongué
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Gestational Hypertension ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Pediatric Care ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
History Of

AbstractBackground: Positive associations have been found between Hypertensive Disorders of Pregnancy gestational hypertension, preeclampsia and cardiovascular diseases within non-black African populations, but no data exist from sub-Saharan Africa. We aimed to assess this association in Cameroonian mothers.Methods: We used a case-control design. Cases were women diagnosed with arteriosclerotic cardiovascular disease between 2012 and 2017 at the General and the Gyneco-obstetric hospital of Yaoundé. Controls were mothers of children who seeked pediatric care at the Gyneco-obstetric hospital of Yaoundé, with no diagnosis of cardiovascular disease. We abstracted data from patient files to assess cardiovascular disease, and used phone-based questionnaires to assess prior history of Hypertensive Disorders of Pregnancy. We used logistic regression and propensity scores for adjustment. Results: Out of 1228 individuals selected, 173 cases and 339 controls participated in the study. We found no increased risk of cardiovascular diseases for women with a history of Hypertensive Disorders of Pregnancy (OR = 0.83, 95% CI, 0.51 to 1.34). Women with gestational hypertension had 2.33 (95% CI, 0.99 to 5.50) times the risk of women with no history of Hypertensive Disorders of Pregnancy, an inverse association was observed between preeclampsia and cardiovascular diseases (OR = 0.28, 95% CI, 0.10 to 0.72). Conclusions: Cameroonian women with a history of gestational hypertension may have an increased risk of cardiovascular diseases. However, population-based studies with more accurate data on the exposure are needed.

scholarly journals Development and Internal Validation of a Model Predicting Premature Cardiovascular Disease Among Women With Hypertensive Disorders of Pregnancy: A Population‐Based Study in Quebec, Canada

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
U. Vivian Ukah ◽  
Natalie Dayan ◽  
Nathalie Auger ◽  
Siyi He ◽  
Robert W. Platt
Keyword(s):  
Cardiovascular Disease ◽  
Risk Stratification ◽  
Prediction Models ◽  
External Validation ◽  
Population Based ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Premature Cardiovascular Disease ◽  
Increased Risk

Background Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of premature cardiovascular disease (CVD), but existing cardiovascular prediction models do not adequately capture risks in young women. We developed a model to predict the 10‐year risk of premature CVD and mortality among women who have HDP. Methods and Results Using a population‐based cohort of women with HDP who delivered between April 1989 and March 2017 in Quebec, Canada, we developed a 10‐year CVD risk model using Cox proportional hazards regression. Women aged 18 to 45 years were followed from their first HDP‐complicated delivery until March 2018. We assessed performance of the model based on discrimination, calibration, and risk stratification ability. Internal validity was assessed using the bootstrap method. The cohort included 95 537 women who contributed 1 401 084 person‐years follow‐up. In total, 4024 (4.2%) of women were hospitalized for CVD, of which 1585 events (1.6%) occurred within 10 years of follow‐up. The final model had modest discriminatory performance (area under the receiver operating characteristic curve, 0.66; 95% CI, 0.65–0.67) and good calibration with slope of 0.95 and intercept of −0.19. There was moderate classification accuracy (likelihood ratio+: 5.90; 95% CI, 5.01–6.95) in the highest‐risk group upon risk stratification. Conclusions Overall, our model had modest performance in predicting the 10‐year risk of premature CVD for women with HDP. We recommend the addition of clinical variables, and external validation, before consideration for clinical use.

scholarly journals Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time

Stroke ◽  
2022 ◽  
Author(s):  
Shih-Kai Hung ◽  
Moon-Sing Lee ◽  
Hon-Yi Lin ◽  
Liang-Cheng Chen ◽  
Chi-Jou Chuang ◽  
...  
Keyword(s):  
Time Trends ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
History Of ◽  
The Relationship

Background and Purpose: Hypertensive disorders of pregnancy (HDP) comprise 4 subtypes. Previous studies have not investigated the relationship between stroke risk, different HDP subtypes, and follow-up time, which was the purpose of this study. Methods: Data of 17 588 women aged 18 to 45 years who had a history of HDP in Taiwan from 2000 to 2017 was retrospectively reviewed. After matching with confounders, 13 617 HDP women and 54 468 non-HDP women were recruited. Results: HDP women had an adjusted hazard ratio (aHR) of 1.71 (95% CI, 1.46−2.00) for stroke, and 1.60 (1.35−1.89) and 2.98 (2.13−4.18) for ischemic and hemorrhagic stroke, respectively ( P <0.001 for all). The overall stroke risk in the HDP group was still 2.04 times 10 to 15 years after childbirth (1.47−2.83, P <0.001). Although the risks of both ischemic and hemorrhagic stroke persisted, their risk time trends were different. The risk of ischemic stroke reached peak during 1 to 3 years after childbirth with an aHR of 2.14 (1.36–3.38), while hemorrhagic stroke risk gradually increased and had an aHR of 4.64 (2.47−8.73) after 10 to 15 years of childbirth (both P <0.001). Among the 4 HDP subtypes, chronic hypertension with superimposed preeclampsia had the highest stroke risk (aHR=3.86, 1.91−7.82, P <0.001), followed by preeclampsia–eclampsia (aHR=2.00, 1.63−2.45, P <0.001), and gestational hypertension (aHR=1.68, 1.13−2.52, P <0.05); chronic preexisting hypertension had the lowest stroke risk (aHR=1.27, 0.97−1.68, P >0.05). Furthermore, multiple HDP combined with preeclampsia had aHR of 5.48 (1.14−26.42, P <0.05). Conclusions: The effect of HDP on the risk of future stroke persisted for up to 17 years, both for ischemic and hemorrhagic strokes. The presence of multiple HDP and preeclampsia further increase the stroke risk.

scholarly journals Pregnancy Induced Hypertension (PIH): Beyond Pregnancy

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Stress Test ◽  
Published Data ◽  
Chronic Hypertension ◽  
Atherosclerotic Cardiovascular Disease ◽  
Pregnancy Induced Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Induced Hypertension

Contrary to the belief that pregnancy-induced hypertension (PIH, or hypertensive disorders of pregnancy, HDP) and preeclampsia are benign conditions that do not extend harm past pregnancy, the evidence is growing that preeclampsia is a risk factor for future cardiovascular disease. Although most published data indicate that proteinuria during pregnancy does no long-term harm to the mother, more recent reports indicate that preeclampsia increases the risk of cardiovascular disease [1-7]. Recent research published on November 11, 2019 in the Journal of the American College of Cardiology confirms that women who have gestational hypertension or preeclampsia in at least one pregnancy have a higher cardiovascular risk than women without this history [7]. The authors conclude that a history of HDP can be a useful tool to refine atherosclerotic cardiovascular disease risk assessments. They added “However, future risk of diverse cardiovascular conditions in asymptomatic middle-aged women with prior HDP remains unknown”. They also argued that “hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated”, and commented that the cardiovascular risk after HDP is largely but not solely mediated by the development of chronic hypertension. Many authorities now regard pregnancy as a “cardiovascular stress test” [8].

Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy

2020 ◽  
Author(s):  
Madeleine Caplan ◽  
Lauren S. Keenan-Devlin ◽  
Alexa Freedman ◽  
William Grobman ◽  
Pathik D. Wadhwa ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Psychosocial Stress ◽  
Gestational Hypertension ◽  
Primary Objective ◽  
Mediation Effect ◽  
Chronic Hypertension ◽  
Stress Exposure ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Increased Risk

Objective Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship. Study Design A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 206/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP. Results Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06–2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03–2.20). No mediation effect by inflammation was observed. Conclusion Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP. Key Points

Hypertensive disorders of pregnancy and later cardiovascular disease risk in mothers and children

2020 ◽  
pp. 1-6
Author(s):  
Michelle D. Plummer ◽  
Prabha H. Andraweera ◽  
Amy Garrett ◽  
Shalem Leemaqz ◽  
Melanie Wittwer ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Microvascular Function ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Female Children

Abstract Preeclampsia (PE) and gestational hypertension (GH) are pregnancy-specific diseases that occur in around 10% of pregnancies worldwide. Increasing evidence suggests that women whose pregnancies were complicated by PE or GH, and their offspring, are at increased risk of cardiovascular disease (CVD) later in life. We hypothesised that PE and GH would associate with CVD risk factors 8–10 years after the first pregnancy in the mother and child and that differences in cardiovascular risk profile would be seen between 8- and 10-year-old male and female children. This is a follow-up study of the Adelaide SCOPE pregnancy cohort where 1164 nulliparous women and their babies were recruited between 2005 and 2008. Haemodynamic function was assessed using non-invasive USCOMBP+ and USCOM1A devices. Microvascular function was assessed by post-occlusive reactive hyperaemia. Of the 273 mother–child pairs followed up, 38 women had PE and 20 had GH during pregnancy. Augmentation index (Aix) and suprasystolic pulse pressure (ssPP) were increased, whereas measures of microvascular function were decreased in children who were born to PE compared to uncomplicated pregnancies. Female children had decreased Aix and ssPP compared to male children after in utero exposure to PE. Women who developed GH during their first pregnancy had increased systolic, diastolic and mean arterial pressures compared to women who had uncomplicated pregnancy. Our data suggest that GH is associated with increased cardiovascular risk in women 8–10 years after first pregnancy and PE is associated with increased offspring risk at 8–10 years of age, highlighting differences between these two hypertensive disorders of pregnancy.

scholarly journals Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046638
Author(s):  
Sk Masum Billah ◽  
Abdullah Nurus Salam Khan ◽  
S M Rokonuzzaman ◽  
Nafisa Lira Huq ◽  
Marufa Aziz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Hypertensive Disorders ◽  
Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

Basal Plate Myometrial Fibers and Hypertensive Disorders of Pregnancy: A Case–Control Study

2017 ◽  
Vol 21 (3) ◽  
pp. 296-299 ◽  
Author(s):  
Ann A Wang ◽  
Linda M Ernst ◽  
Emily S Miller
Keyword(s):  
Case Control Study ◽  
Gestational Hypertension ◽  
Case Control ◽  
Basal Plate ◽  
Common Finding ◽  
Pathological Examination ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Control Study

Introduction Basal plate myometrium (BPMYO), the pathological presence of myometrial fibers in the basal plate, is a common finding on pathological examination of the placenta, yet its clinical correlates are not well studied. As myometrial fibers are frequently located in proximity to poorly converted maternal spiral arteries, our objective was to determine whether BPMYO is associated with hypertensive disorders of pregnancy (HDP), a well-known clinical sequela of abnormal maternal artery remodeling. Methods This case–control study included women who delivered a live-born singleton gestation whose placentas were sent for pathological examination. Cases were women with HDP (gestational hypertension, preeclampsia, or HELLP syndrome) as defined by American College of Obstetricians and Gynecologists. Controls were women without HDP. Women with chronic hypertension were excluded. The primary outcome was the presence of BPMYO. Secondary outcomes included the pathologic stage of BPMYO and the incidence of pathologically defined accreta. Each outcome was compared between cases and controls in bivariable and multivariable analyses. Results Of the 306 women who met inclusion criteria, 230 (75%) had HDP. BPMYO was present in 99 (32%) of placentas. Compared to controls, cases were younger, had higher body mass index, and were more likely to have diabetes, be nulliparous, deliver preterm, and have had a prior cesarean. There were no differences in the incidence of BPMYO, stage of BPMYO, or incidence of pathologically defined accreta between cases and controls. These findings persisted after controlling for potential confounders. Conclusions Although BPMYO may be more common in the setting of abnormal placental vasculature, there is no significant association between BPMYO and HDP.

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