Longitudinal Management of Cardiovascular Risk Factors Among Postpartum Women
Publication: Journal of Women's Health
Volume 33, Issue Number 7
Abstract
Background: Pregnancy-related cardiovascular (CV) conditions, including hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM), are associated with increased long-term CV risk.
Methods: This retrospective cohort study defined the prevalence of HDP and GDM within a large, academic health system in the southeast United States between 2012 and 2015 and described health care utilization and routine CV screening up to 1-year following delivery among those with pregnancy-related CV conditions. Rates of follow-up visits and blood pressure, hemoglobin A1c (HbA1c), and lipid screening in the first postpartum year were compared by provider type and pregnancy-related CV condition.
Results: Of the 6027 deliveries included, 20% were complicated by HDP and/or GDM. Rates of pre-pregnancy CV risk factors were high, with a significantly higher proportion of pre-pregnancy obesity among women with HDP than in normal pregnancies. Those with both HDP/GDM had the highest rates of follow-up by 1-year postpartum, yet only half of those with any pregnancy-related CV condition had any follow-up visit after 12 weeks. Although most (70%) of those with HDP had postpartum blood pressure screening, less than one-third of those with GDM had a repeat HbA1c by 12 months. Overall, postpartum lipid screening was rare (<20%).
Conclusion: There is a high burden of pregnancy-related CV conditions in a large U.S. academic health system. Although overall rates of follow-up in the early postpartum period were high, gaps in longitudinal follow-up exist. Low rates of CV risk factor follow-up at 1 year indicate a missed opportunity for early CV prevention.
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Copyright 2024, Mary Ann Liebert, Inc., publishers.
History
Published online: 4 July 2024
Published in print: July 2024
Published ahead of print: 27 March 2024
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Authors’ Contributions
R.L.: conceptualization; methodology; writing—original draft; visualization; project administration; funding acquisition. C.B.P.: formal analysis; data curation; writing—review and editing; visualization. M.P.: methodology; software; formal analysis; data curation; visualization. S.W.: conceptualization; writing—review and editing. N.P.: conceptualization; methodology; writing—review and editing; supervision; funding acquisition.
Author Disclosure Statement
Dr. Pagidipati reports: Research support from Alnylam, Amgen, Bayer, Boehringer Ingelheim, Eggland’s Best, Eli Lilly, Novartis, Novo Nordisk, Merck. Consultation/Advisory Panels for Bayer, Boehringer Ingelheim, CRISPR Therapeutics, Eli Lilly, Esperion, AstraZeneca, Merck, Novartis, and Novo Nordisk. Executive Committee member for trials sponsored by Novo Nordisk and Amgen. Drug-safety monitoring board for trials sponsored by J + J and Novartis. Medical advisory board for Miga Health. The remaining authors have no disclosures to report.
Funding Information
This project was internally funded; no external funding sources to report.
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