New Guidance Helps Manage Heart Disease Risk After Pregnancy Complications

Cardiovascular disease (CVD) is the leading cause of death in women, and there are many common pregnancy complications that are indicators of increased risk. These include preeclampsia, gestational diabetes, and preterm delivery.

This is further emphasized for women of color, who develop CVD earlier and at higher rates. Additionally, Black women are three times more likely to die from a pregnancy-related cause than white women. With CVD accounting for nearly 30% of all pregnancy related deaths, screening for these indicators could be the difference between life and death.

The year following pregnancy is an important time to identify individuals at higher risk for future heart disease, provide counseling, and begin preventive care. However, clinicians lack a single source of comprehensive guidance on how to assess and manage risk after obstetric complications.

To address that need, researchers at Boston Medical Center have created a new resource that does exactly that. The review was recently published in the Journal of General Internal Medicine.

“Our review synthesizes all the recommendations to provide a one-stop shop for primary care clinicians taking care of individuals in the year following a complicated pregnancy,” says Mara Murray Horwitz, MD MPH, a primary care physician in BMC’s Women’s Health Unit.

“We hope our findings will lead to better identification and management of heart disease risk for many birthing people.”

Recommendations for clinicians about managing heart disease

Conducting a systematic review of clinical practice guidelines and professional society recommendations, the researchers identified several areas of consensus.

• Screening everyone who has previously given birth for a history of pregnancy complications associated with future heart disease risk
• Comprehensive heart-disease risk screen within the first postpartum year for all those already identified with pregnancy complications associated with future heart disease risk
• Individualized counseling and lifestyle modification to reduce long-term heart disease

The few current clinical practice recommendations for primary care focus on the need for risk assessment, patient education, and lifestyle modification to prevent cardiovascular disease. Primary care clinicians have a teachable window following the year after pregnancy and must be able to identify adverse pregnancy outcomes associated with future cardiovascular disease, educate and empower patients about their risk factors, and support healthy behavior changes.

“The connections between pregnancy complications and future chronic diseases are becoming increasingly clear, but more studies are needed on how this pathway can be interrupted or modified,” says Murray Horwitz, assistant professor of medicine at Boston University School of Medicine.

“Most recommendations for birthing people currently focus on postpartum lifestyle modification, but behavioral change can be difficult, especially in the postpartum context.”

Researchers believe that future studies should focus on how best to support postpartum individuals to promote their long-term heart health.