Top Things to Know: Opportunities in the Postpartum period to Reduce CV Disease Risk After Adverse Pregnancy Outcomes
Published: February 12, 2024
Prepared by Anne Leonard MPH, BSN, RN, FAHA; National Senior Director Science and Medicine
- Adverse pregnancy outcomes (APOs) are common in pregnant individuals and are associated with long-term risk of cardiovascular disease.
- APOs can arise from stress of metabolic and vascular changes during pregnancy and includes:
- Maternal or fetal complications, such as hypertensive disorders of pregnancy (HDP) (HDP), HELLP (hemolysis, elevated liver enzymes, low platelets), gestational diabetes, placental abruption, spontaneous preterm birth, fetal growth restriction and small-for-gestational age (SGA) infant.
- APOs can herald higher risk of future long-term complications, which include increased lifetime risk of atherosclerotic cardiovascular disease (ASCVD), heart failure stroke, chronic kidney disease (CKD) and vascular dementia.
- Women with HDP have a 2-4-fold increase in risk of developing chronic hypertension compared with women with normotensive pregnancies at 10-20 yeas or later after delivery. This paper offers suggestions on how to manage HDP during and after pregnancy.
- The interpregnancy period offers and ideal opportunity to reduce risk of future pregnancy complications for women who plan on future pregnancy. This window is called the postpartum and interpregnancy period.
- Breastfeeding has many benefits for maternal and offspring cardiovascular health. One example given in this paper is the longer the duration of breastfeeding as association has been seen with a lower risk of type 2 diabetes.
- Patient education using the AHA’s Life’s Essential 8 model for lifestyle modification can direct both pregnant women and clinicians on targets for cardiovascular risk management and can be used through a woman’s lifespan who have experienced APOs.
- Postpartum and Interpregnancy counseling for patients with HDP, gestational diabetes and other APOs such as placental abruption, SGA infant and preterm birth. The areas discussed in this statement include counseling, management of these APOs, lactation considerations, subsequent pregnancies, and contraception.
- This statement suggests interventions to reduce CVD risk according to an ecological framework that includes the individual, health care professionals, the health systems and community.
- Clinicians need to be proactive in mitigating APOs in the postpartum period that are associated with short and long-term risks of CVD and using tools such as the AHAs Life’s Essential 8 as a guide to this end. Studies targeting long-term reduction of CVD risk and policy level changes that mitigate the impact of social determinants of health along with innovative health care delivery strategies are paramount to achieving lower rates of APOs in pregnancy and lowering long-term risks post pregnancy.
Citation
Lewey J, Beckie TM, Brown HL, Brown SD, Garovic VD, Khan SS, Miller EC, Sharma G, Mehta LS; on behalf of the American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; and Council on Cardiovascular and Stroke Nursing. Opportunities in the postpartum period to reduce cardiovascular disease risk after adverse pregnancy outcomes: a scientific statement from the American Heart Association. Circulation. Published online February 13, 2024. doi: 10.1161/CIR.0000000000001212