Variations in Awareness of Association Between Adverse Pregnancy Outcomes and Cardiovascular Risk by Specialty

Abstract

Introduction: Cardiovascular disease (CVD) remains the leading cause of death among women. Adverse pregnancy outcomes (APOs), including pre-eclampsia (PE), gestational diabetes mellitus (GDM) and pre-term birth (PTB) are associated with future maternal CVD risk. However, data on awareness of the association between APOs and long-term CVD risk among physicians in different specialties are lacking.This study assessed awareness of this association and whether this knowledge varies by specialty. Methods: An anonymous web-based voluntary survey was sent to physicians in internal medicine (IM), family medicine (FM), obstetrics-gynecology (Ob-Gyn) and cardiology. The questions aimed to assess a physician's knowledge regarding identification of APOs and their association with future CVD risk and knowledge of CVD risk factor screening in women with APOs and future CVD risk. Results: The survey was completed by 53 physicians, of whom 21% were in IM, 26% in FM, 23% in Ob-Gyn and 30% in cardiology. Based on the responses, cardiologists screened most frequently for APOs, with 56% always screening a female patient and 31% often screening. Only half of the IM and FM physicians acknowledged awareness of the association between APOs and CVD risk. Respondents in all specialties recognized PE and GDM as APOs linked to long-term maternal CVD risk, but failed to associate PTB as an APO. The majority of physicians in IM, FM and cardiology also lacked the knowledge of how often to appropriately screen for CVD risk factors associated with APOs. Conclusion: Awareness of the association between APO and future maternal CVD risk varies by specialty. A significant percentage of the physicians who responded to the survey did not routinely ask about APOs when assessing CVD risk and failed to identify PTB as a risk

Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study

“… 13 However, adverse pregnancy outcomes still remain under-recognized as potential cardiovascular risk factors, especially in primary care where most women are managed. 14 Our findings underscore the importance of including adverse pregnancy outcomes in the evaluation of cardiovascular risk for women in primary care as well as in specialty clinic settings. Adverse pregnancy outcomes should be routinely tracked in electronic health records to facilitate transition of women from obstetric to primary care clinics where they should undergo early risk evaluation for cardiovascular disease.…”

“…The American Heart Association has recommended that evaluation of cardiovascular risk in women routinely include taking a history of adverse pregnancy outcomes 13. However, adverse pregnancy outcomes still remain under-recognized as potential cardiovascular risk factors, especially in primary care where most women are managed 14. Our findings underscore the importance of including adverse pregnancy outcomes in the evaluation of cardiovascular risk for women in primary care as well as in specialty clinic settings.…”

“… 12 Despite this evidence, however, adverse pregnancy outcomes remain under-recognized as potential cardiovascular risk factors and are often overlooked when assessing risks in women. 13 14 About 85% of women in high income countries deliver at least one child, 15 16 and up to one third of pregnancies are affected by at least one adverse pregnancy outcome, 4 17 thus nearly 30% of women experience an adverse pregnancy outcome during their reproductive years. 4 17 A better understanding of the long term risks associated with specific adverse pregnancy outcomes is needed to improve risk stratification and guide preventive strategies to reduce the burden of cardiovascular disease in women.…”

“…Adverse pregnancy outcomes share certain pathogenetic features, including abnormal placentation, inflammation, and vascular dysfunction, that may lead to subclinical cardiovascular disease that persists or progresses after delivery 12. Despite this evidence, however, adverse pregnancy outcomes remain under-recognized as potential cardiovascular risk factors and are often overlooked when assessing risks in women 1314. About 85% of women in high income countries deliver at least one child,1516 and up to one third of pregnancies are affected by at least one adverse pregnancy outcome,417 thus nearly 30% of women experience an adverse pregnancy outcome during their reproductive years 417.…”

Temporal Trends in Adverse Pregnancy Outcomes in Birthing Individuals Aged 15 to 44 Years in the United States, 2007 to 2019

“…However, use of primary care remains low, even among individuals with medically complicated pregnancies. 31 Furthermore, awareness of the association between APOs and future maternal CVD varies by specialty, 32 and dedicated physician and patient education is crucial.…”