Knowledge and care regarding long-term cardiovascular risk after hypertensive disorders of pregnancy and gestational diabetes.
Cardiovascular disease
Fourth Trimester
Gestational Diabetes mellitus
Postpartum Care
Preeclampsia
Journal
Wiener klinische Wochenschrift
ISSN: 1613-7671
Titre abrégé: Wien Klin Wochenschr
Pays: Austria
ID NLM: 21620870R
Informations de publication
Date de publication:
03 Jan 2024
03 Jan 2024
Historique:
received:
19
07
2023
accepted:
22
11
2023
medline:
4
1
2024
pubmed:
4
1
2024
entrez:
3
1
2024
Statut:
aheadofprint
Résumé
Adverse pregnancy outcomes (APO), such as preeclampsia (PE) and gestational diabetes (GDM) are substantial risk factors for cardiovascular disease (CVD) later in life. Identifying these high-risk female individuals during pregnancy offers the possibility of preventing long-term CVD and chronic kidney disease via a structured therapeutic and surveillance plan. We aimed to evaluate the current practice of postpartum care in women after APO and the impact on the women's awareness about their future risk for CVD. Women diagnosed with PE and GDM at the University Hospital of St. Poelten/Lilienfeld between 2015-2020 were identified and participated in a structured telephone interview about postpartum medical care and knowledge about the impact of APOs on long-term cardiovascular health. Of 161 out of the 750 women contacted, 29% (n = 46) were diagnosed with PE and 71% (n = 115) with GDM. One third of all women and up to 44% of women diagnosed with PE, were unaware that APOs are related to CVD. Women diagnosed with PE were less likely to receive postpartum care information than those with GDM (30.4% vs. 49.6%, p = 0.027), and only one third of all women after APOs were counselled by a physician or healthcare professional. Of the women 50% received recommendations regarding lifestyle changes after delivery; significantly more women with GDM than women with PE (54% vs. 37%, p = 0.05). Only 14% had at least one long-term follow-up. This study identified a significant deficit of structured postpartum care and a lack of awareness among women after APO and their healthcare providers about the increased risk of long-term CVD.
Sections du résumé
BACKGROUND
BACKGROUND
Adverse pregnancy outcomes (APO), such as preeclampsia (PE) and gestational diabetes (GDM) are substantial risk factors for cardiovascular disease (CVD) later in life. Identifying these high-risk female individuals during pregnancy offers the possibility of preventing long-term CVD and chronic kidney disease via a structured therapeutic and surveillance plan. We aimed to evaluate the current practice of postpartum care in women after APO and the impact on the women's awareness about their future risk for CVD.
METHODS
METHODS
Women diagnosed with PE and GDM at the University Hospital of St. Poelten/Lilienfeld between 2015-2020 were identified and participated in a structured telephone interview about postpartum medical care and knowledge about the impact of APOs on long-term cardiovascular health.
RESULTS
RESULTS
Of 161 out of the 750 women contacted, 29% (n = 46) were diagnosed with PE and 71% (n = 115) with GDM. One third of all women and up to 44% of women diagnosed with PE, were unaware that APOs are related to CVD. Women diagnosed with PE were less likely to receive postpartum care information than those with GDM (30.4% vs. 49.6%, p = 0.027), and only one third of all women after APOs were counselled by a physician or healthcare professional. Of the women 50% received recommendations regarding lifestyle changes after delivery; significantly more women with GDM than women with PE (54% vs. 37%, p = 0.05). Only 14% had at least one long-term follow-up.
CONCLUSION
CONCLUSIONS
This study identified a significant deficit of structured postpartum care and a lack of awareness among women after APO and their healthcare providers about the increased risk of long-term CVD.
Identifiants
pubmed: 38170219
doi: 10.1007/s00508-023-02313-1
pii: 10.1007/s00508-023-02313-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56–e528.
doi: 10.1161/CIR.0000000000000659
pubmed: 30700139
Cho L, Davis M, Elgendy I, Epps K, Lindley KJ, Mehta PK, et al. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(20):2602–18.
Sattar N, Greer IA. Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening? BMJ. 2002;325(7356):157–60.
doi: 10.1136/bmj.325.7356.157
pubmed: 12130616
pmcid: 1123678
Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022;27:148–69.
doi: 10.1016/j.preghy.2021.09.008
pubmed: 35066406
Grandi SM, Filion KB, Yoon S, Ayele HT, Doyle CM, Hutcheon JA, et al. Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications. Circulation. 2019;139(8):1069–79.
doi: 10.1161/CIRCULATIONAHA.118.036748
pubmed: 30779636
Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.
doi: 10.1136/bmj.39335.385301.BE
pubmed: 17975258
pmcid: 2072042
Honigberg MC, Zekavat SM, Aragam K, Klarin D, Bhatt DL, Scott NS, et al. Long-Term Cardiovascular Risk in Women With Hypertension During Pregnancy. J Am Coll Cardiol. 2019;74(22):2743–54.
doi: 10.1016/j.jacc.2019.09.052
pubmed: 31727424
pmcid: 6981240
Stuart JJ, Tanz LJ, Cook NR, Spiegelman D, Missmer SA, Rimm EB, et al. Hypertensive Disorders of Pregnancy and 10-Year Cardiovascular Risk Prediction. J Am Coll Cardiol. 2018;72(11):1252–63.
doi: 10.1016/j.jacc.2018.05.077
pubmed: 30190003
pmcid: 6136445
Groenhof TKJ, van Rijn BB, Franx A, Roeters van Lennep JE, Bots ML, Lely AT. Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when. Eur J Prev Cardiol. 2017;24(16):1735–45.
doi: 10.1177/2047487317730472
pubmed: 28895439
pmcid: 5669282
Callaway LK, Lawlor DA, O’Callaghan M, Williams GM, Najman JM, McIntyre HD. Diabetes mellitus in the 21 years after a pregnancy that was complicated by hypertension: findings from a prospective cohort study. Am J Obstet Gynecol. 2007;197(5):492:e1–7.
Zhao G, Bhatia D, Jung F, Lipscombe L. Risk of type 2 diabetes mellitus in women with prior hypertensive disorders of pregnancy: a systematic review and meta-analysis. Diabetologia. 2021;64(3):491–503.
doi: 10.1007/s00125-020-05343-w
pubmed: 33409572
Garovic VD, White WM, Vaughan L, Saiki M, Parashuram S, Garcia-Valencia O, et al. Incidence and Long-Term Outcomes of Hypertensive Disorders of Pregnancy. J Am Coll Cardiol. 2020;75(18):2323–34.
doi: 10.1016/j.jacc.2020.03.028
pubmed: 32381164
pmcid: 7213062
Barrett PM, McCarthy FP, Kublickiene K, Cormican S, Judge C, Evans M, et al. Adverse Pregnancy Outcomes and Long-term Maternal Kidney Disease: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(2):e1920964.
Garovic VD, Piccoli GB. A kidney-centric view of pre-eclampsia through the kidney-placental bidirectional lens. Kidney Int. 2023;104(2):213–7.
doi: 10.1016/j.kint.2023.04.030
pubmed: 37479381
Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia. 2019;62(6):905–14.
doi: 10.1007/s00125-019-4840-2
pubmed: 30843102
Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ. 2020;369:m1361.
doi: 10.1136/bmj.m1361
pubmed: 32404325
pmcid: 7218708
Kautzky-Willer A, Harreiter J, Abrahamian H, Weitgasser R, Fasching P, Hoppichler F, et al. Sex and gender-specific aspects in prediabetes and diabetes mellitus-clinical recommendations (Update 2019). Wien Klin Wochenschr. 2019;131(Suppl 1):221–8.
doi: 10.1007/s00508-018-1421-1
pubmed: 30980153
Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(5):1545–88.
American Diabetes A. 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):137–S43.
doi: 10.2337/dc18-S013
American College of O, Gynecologists, Task Force on Hypertension in P. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122–31.
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. J Am Coll Cardiol. 2011;57(12):1404–23.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):1376–414.
doi: 10.1016/j.jacc.2019.03.009
pubmed: 30894319
pmcid: 8344373
Roth H, LeMarquand G, Henry A, Homer C. Assessing Knowledge Gaps of Women and Healthcare Providers Concerning Cardiovascular Risk After Hypertensive Disorders of Pregnancy—A Scoping Review. Front Cardiovasc Med. 2019;6:178.
doi: 10.3389/fcvm.2019.00178
pubmed: 31850374
pmcid: 6895842
Tobias DK, Stuart JJ, Li S, Chavarro J, Rimm EB, Rich-Edwards J, et al. Association of History of Gestational Diabetes With Long-term Cardiovascular Disease Risk in a Large Prospective Cohort of US Women. JAMA Intern Med. 2017;177(12):1735–42.
doi: 10.1001/jamainternmed.2017.2790
pubmed: 29049820
pmcid: 5820722
MacDonald SE, Walker M, Ramshaw H, Godwin M, Chen XK, Smith G. Hypertensive disorders of pregnancy and long-term risk of hypertension: what do Ontario prenatal care providers know, and what do they communicate? J Obstet Gynaecol Can. 2007;29(9):705–10.
doi: 10.1016/S1701-2163(16)32601-9
pubmed: 17825134
Parikh NI, Gonzalez JM, Anderson CAM, Judd SE, Rexrode KM, Hlatky MA, et al. Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association. Circulation. 2021;143(18):e902–e16.
doi: 10.1161/CIR.0000000000000961
pubmed: 33779213
Aldridge E, Verburg PE, Sierp S, Andraweera P, Dekker GA, Roberts CT, et al. A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population. Front Cardiovasc Med. 2019;6:184.
doi: 10.3389/fcvm.2019.00184
pubmed: 31970161
Sutherland L, Neale D, Henderson J, Clark J, Levine D, Bennett WL. Provider Counseling About and Risk Perception for Future Chronic Disease Among Women with Gestational Diabetes and Preeclampsia. J Womens Health (larchmt). 2020;.
Garovic VD, Dechend R, Easterling T, Karumanchi SA, McMurtry BS, Magee LA, et al. Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2022;79(2):e21–e41.
doi: 10.1161/HYP.0000000000000208
pubmed: 34905954
Knight M, Bunch K, Patel R, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ, editors. Saving lives, improving mothers’ care: Core report: Lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2018–20. MBRRACE-UK. 2022. https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2022/MBRRACE-UK_Maternal_MAIN_Report_2022_v10.pdf ..
Beussink-Nelson L, Baldridge AS, Hibler E, Bello NA, Epps K, Cameron KA, et al. Knowledge and perception of cardiovascular disease risk in women of reproductive age. Am J Prev Cardiol. 2022;11:100364.
doi: 10.1016/j.ajpc.2022.100364
pubmed: 35866048
pmcid: 9294042
Bijl RC, Bangert SE, Shree R, Brewer AN, Abrenica-Keffer N, Tsigas EZ, et al. Patient journey during and after a pre-eclampsia-complicated pregnancy: a cross-sectional patient registry study. Bmj Open. 2022;12(3):e57795.
doi: 10.1136/bmjopen-2021-057795
pubmed: 35241475
pmcid: 8896051
Hird M, Yoshizawa R, Robinson S, Smith G, Walker M. Risk for cardiovascular disease after pre-eclampsia: differences in Canadian women and healthcare provider perspectives on knowledge sharing. Health Sociol Rev. 2016;26:1–15.
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227–337.
doi: 10.1093/eurheartj/ehab484
pubmed: 34458905
Khan SS, Brewer LC, Canobbio MM, Cipolla MJ, Grobman WA, Lewey J, et al. Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association. Circulation. 2023;147(7):e76–e91.
doi: 10.1161/CIR.0000000000001124
pubmed: 36780391
Jowell AR, Sarma AA, Gulati M, Michos ED, Vaught AJ, Natarajan P, et al. Interventions to Mitigate Risk of Cardiovascular Disease After Adverse Pregnancy Outcomes: A Review. JAMA Cardiol. 2022;7(3:346–55.
doi: 10.1001/jamacardio.2021.4391
Jääskeläinen T, Kivelä A, Renlund M, Heinonen S, Aittasalo M, Laivuori H, et al. Protocol: A randomized controlled trial to assess effectiveness of a 12-month lifestyle intervention to reduce cardiovascular disease risk in families ten years after pre-eclampsia (FINNCARE). Prev Med Rep. 2022;26:101731.
doi: 10.1016/j.pmedr.2022.101731
pubmed: 35242500
pmcid: 8861388
Rossi A, Mikail N, Bengs S, Haider A, Treyer V, Buechel RR, et al. Heart-brain interactions in cardiac and brain diseases: why sex matters. Eur Heart J. 2022;43(39):3971–80.
doi: 10.1093/eurheartj/ehac061
pubmed: 35194633
pmcid: 9794190