Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association

Abstract

Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life’s Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.

Improvements in Maternal Cardiovascular Health Over the Perinatal Period Longitudinally Predict Lower Postpartum Psychological Distress Among Individuals Who Began Their Pregnancies With Overweight or Obesity

“…This is consistent with a recent scientific statement from the AHA proposing that use of the LE8 to assess CVH during the perinatal period represents an opportunity to reduce maternal CVD risk. 68 …”

Perceptions of Chinese women with a history of gestational diabetes regarding health behaviors and related factors: a directed qualitative content analysis

“…A similar study performed in the United States, the National Diabetes Prevention Program [ 9 ], which had the goals of a ≥ 7% weight loss and 150 min of physical activity per week, reduced the incidence of diabetes in patients at high risk by 58%. According to the statement position of the American Heart Association [ 10 ] and the American Diabetes Association [ 11 ] on postpartum and interpregnancy management of GDM, women should undergo oral glucose tolerance testing (OGTT) 4–12 weeks postpartum, weight loss and exercise for diabetes prevention, etc. However, following childbirth, most women do not make the appropriate lifestyle adjustments or undergo OGTT as recommended.…”

Adverse pregnancy outcomes and coronary artery disease risk: A negative control Mendelian randomization study

“…Adverse pregnancy outcomes such as preterm birth are strongly associated with future maternal risk of cardiovascular diseases. 1–3 Given that close to a third of females experience an adverse pregnancy outcome during their lifetime, the American Heart Association, among many other societies, are recommending that a history of adverse pregnancy outcomes are taken into account when assessing future risk of cardiovascular diseases. 1–3…”

“…Adverse pregnancy outcomes such as preterm birth are strongly associated with future maternal risk of cardiovascular diseases. [1][2][3] Given that close to a third of females experience an adverse pregnancy outcome during their lifetime, the American Heart Association, among many other societies, are recommending that a history of adverse pregnancy outcomes are taken into account when assessing future risk of cardiovascular diseases. [1][2][3] While the predictive properties of adverse pregnancy outcomes on future risk of cardiovascular diseases are clear, it is unknown whether they play a causal role in the development of cardiovascular diseases, although some biological mechanisms have been hypothesized.…”

“…[1][2][3] Given that close to a third of females experience an adverse pregnancy outcome during their lifetime, the American Heart Association, among many other societies, are recommending that a history of adverse pregnancy outcomes are taken into account when assessing future risk of cardiovascular diseases. [1][2][3] While the predictive properties of adverse pregnancy outcomes on future risk of cardiovascular diseases are clear, it is unknown whether they play a causal role in the development of cardiovascular diseases, although some biological mechanisms have been hypothesized. 2 The American Heart Association's scientific statement includes language such as "[Adverse pregnancy outcomes] increase a woman's risk of … [cardiovascular diseases]" which may be interpreted as a causal relationship.…”