Seizing the Window of Opportunity Within 1 Year Postpartum: Early Cardiovascular Screening

Abstract

Background Our objective was to assess new chronic hypertension 6 to 12 months postpartum for those with hypertensive disorder of pregnancy (HDP) compared with normotensive participants. Methods and Results We performed a prospective cohort study of participants with singleton gestations and no known preexisting medical conditions who were diagnosed with HDP compared with normotensive women with no pregnancy complications (non‐HDP). Participants underwent cardiovascular risk assessment 6 to 12 months after delivery. Primary outcome was onset of new chronic hypertension at 6 to 12 months postpartum. We also examined lipid values, metabolic syndrome, prediabetes, diabetes, and 30‐year cardiovascular disease (CVD) risk. Multivariable logistic regression was performed to assess the association between HDP and odds of a postpartum diagnosis of chronic hypertension while adjusting for parity, body mass index, insurance, and family history of CVD. There were 58 participants in the HDP group and 51 participants in the non‐HDP group. Baseline characteristics between groups were not statistically different. Participants in the HDP group had 4‐fold adjusted odds of developing a new diagnosis of chronic hypertension 6 to 12 months after delivery, compared with those in the non‐HDP group (adjusted odds ratio, 4.60 [95% CI, 1.65–12.81]), when adjusting for body mass index, parity, family history of CVD, and insurance. Of the HDP group, 58.6% (n=34) developed new chronic hypertension. Participants in the HDP group had increased estimated 30‐year CVD risk and were more likely to have metabolic syndrome, a higher fasting blood glucose, and higher low‐density lipoprotein cholesterol. Conclusions Participants without known underlying medical conditions who develop HDP have 4‐fold increased odds of new diagnosis of chronic hypertension by 6 to 12 months postpartum as well as increased 30‐year CVD risk scores. Implementation of multidisciplinary care models focused on CVD screening, patient education, and lifestyle interventions during the first year postpartum may serve as an effective primary prevention strategy for the development of CVD.

Cardiovascular Health in Women With Pregnancy‐Related Risk Enhancers: Putting Evidence Into Action

“… 8 A large fraction of the health risks in these women is therefore concealed, 9 leading to the loss of an effective window of opportunity for timely prevention. 10 To strengthen the incorporation of these sex‐specific risk factors into the clinical cardiovascular assessment, 11 a detailed inquiry into the obstetric and gynecological history is required. The recent American Heart Association/American College of Cardiology clinical guidelines highlighted the concept of the risk enhancers.…”