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Garr Barry V, Martin SL, Schneider-Worthington C, Zhao P, Woolfolk CL, Foraker R, Davis KL, Kelly JC, Raghuraman N, England SK, Carter EB. Individual-Level and Community-Level Predictors of Healthy Pregnancy Outcomes in Multigravid Black Women. Obstet Gynecol 2024; 144:241-251. [PMID: 39024647 DOI: 10.1097/aog.0000000000005634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/04/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To identify individual- and community-level factors that predict the odds of multigravid Black women having consecutive pregnancies without adverse pregnancy outcomes. METHODS We conducted a secondary analysis of 515 multigravid Black women from a longitudinal observational study (2017-2019). We assessed the presence of adverse pregnancy outcomes (hypertensive disorders, gestational diabetes, preterm birth, fetal growth restriction, placental abruption, and pregnancy loss) for the index and prior pregnancies. We examined U.S. Census data, medical records, and surveys across multiple socioecologic domains: personal, behavioral, socioeconomic, and policy. We estimated adjusted odds ratios (aORs) and 95% CIs for the association between individual- and community-level factors and consecutive healthy pregnancies using hierarchical logistic regression models adjusted for maternal age, body mass index (BMI), gravidity, interpregnancy interval, and median household income. RESULTS Among 515 multigravid Black women (age 27±5 years, BMI 31.4±8.9, gravidity 4±2), 38.4% had consecutive healthy pregnancies without adverse pregnancy outcomes. Individual-level factors associated with consecutive healthy pregnancies included normal glucose tolerance (aOR 3.9, 95% CI, 1.2-12.1); employment (aOR 1.9, 95% CI, 1.2-2.9); living in communities with favorable health indicators for diabetes, hypertension, and physical activity; and household income of $50,000 per year or more (aOR 3.5, 95% CI, 1.4-8.7). When individual and community factors were modeled together, only income and employment at the individual and community levels remained significant. CONCLUSION Individual and community income and employment are associated with consecutive healthy pregnancies in a cohort of Black patients, emphasizing the need for comprehensive, multilevel systems interventions to reduce adverse pregnancy outcomes for Black women.
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Affiliation(s)
- Valene Garr Barry
- Division of Clinical Research, the Division of Maternal Fetal Medicine, and the Center for Reproductive Health Sciences, Department of Obstetrics & Gynecology, the Division of General Medical Sciences, and the Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri; the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; and the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Boakye E, Oyeka CP, Kwapong YA, Metlock FE, Khan SS, Mamas MA, Perak AM, Douglas PS, Honigberg MC, Nasir K, Blaha MJ, Sharma G. Cardiovascular Risk Profile Among Reproductive-Aged Women in the U.S.: The Behavioral Risk Factor Surveillance System, 2015-2020. AJPM FOCUS 2024; 3:100210. [PMID: 38766464 PMCID: PMC11096844 DOI: 10.1016/j.focus.2024.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction Suboptimal cardiovascular health is associated with adverse pregnancy outcomes and long-term cardiovascular risk. The authors examined trends in cardiovascular risk factors and correlates of suboptimal cardiovascular risk profiles among reproductive-aged U.S. women. Methods With data from 335,959 women in the Behavioral Risk Factor Surveillance System (2015-2020), the authors conducted serial cross-sectional analysis among nonpregnant reproductive-aged women (18-44 years) without cardiovascular disease who self-reported information on 8 cardiovascular risk factors selected on the basis of Life's Essential 8 metrics. The authors estimated the prevalence of each risk factor and suboptimal cardiovascular risk profile (≥2 risk factors) and examined trends overall and by age and race/ethnicity. Using multivariable Poisson regression, the authors assessed the sociodemographic correlates of suboptimal cardiovascular risk profile. Results The weighted prevalence of women aged <35 years was approximately 64% in each survey year. The prevalence of suboptimal cardiovascular risk profile increased modestly from 72.4% (71.6%-73.3%) in 2015 to 75.9% (75.0%-76.7%) in 2019 (p<0.001). This increase was mainly driven by increases in overweight/obesity (53.1%-58.4%; p<0.001). Between 2015 and 2019, significant increases in suboptimal cardiovascular risk profile were observed among non-Hispanic White (69.8%-72.6%; p<0.001) and Hispanic (75.1%-80.3%; p<0.001) women but not among non-Hispanic Black (82.7%-83.7%; p=0.48) or Asian (68.1%-73.2%; p=0.09) women. Older age, rural residence, and non-Hispanic Black and Hispanic race and ethnicity were associated with a higher prevalence of suboptimal cardiovascular risk profile. Conclusions There has been a modest but significant increase in suboptimal cardiovascular risk profile among U.S. women of reproductive age. Urgent preventive efforts are needed to reverse this trend and improve cardiovascular health, particularly among subgroups at increased risk, to mitigate its implications.
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Affiliation(s)
- Ellen Boakye
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Chigolum P. Oyeka
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Yaa A. Kwapong
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | | | - Sadiya S. Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mamas A. Mamas
- Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Staffordshire, United Kingdom
| | - Amanda M. Perak
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Pamela S. Douglas
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Michael C. Honigberg
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist, Houston, Texas
| | - Michael J. Blaha
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins Medicine, Baltimore, Maryland
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, Virginia
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Field C, Grobman WA, Wu J, Kuang A, Scholtens DM, Lowe WL, Shah NS, Khan SS, Venkatesh KK. Elevated Blood Pressure in Pregnancy and Long-Term Cardiometabolic Health Outcomes. Obstet Gynecol 2024:00006250-990000000-01112. [PMID: 39013363 DOI: 10.1097/aog.0000000000005674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/30/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To examine the association between elevated blood pressure (BP) in the early third trimester and cardiometabolic health 10-14 years after delivery. METHODS This is a secondary analysis from the prospective HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study). Blood pressure in the early third trimester was categorized per American College of Cardiology/American Heart Association thresholds for: normal BP below 120/80 mm Hg (reference), elevated BP 120-129/below 80 mm Hg, stage 1 hypertension 130-139/80-89 mm Hg, and stage 2 hypertension 140/90 mm Hg or higher. Cardiometabolic outcomes assessed 10-14 years after the index pregnancy were type 2 diabetes mellitus and measures of dyslipidemia, including low-density lipoprotein (LDL) cholesterol 130 mg/dL or higher, total cholesterol 200 mg/dL or higher, high-density lipoprotein (HDL) cholesterol 40 mg/dL or lower, and triglycerides 200 mg/dL or higher. Adjusted analysis was performed with the following covariates: study field center, follow-up duration, age, body mass index (BMI), height, family history of hypertension and diabetes, smoking and alcohol use, parity, and oral glucose tolerance test glucose z score. RESULTS Among 4,692 pregnant individuals at a median gestational age of 27.9 weeks (interquartile range 26.6-28.9 weeks), 8.5% (n=399) had elevated BP, 14.9% (n=701) had stage 1 hypertension, and 6.4% (n=302) had stage 2 hypertension. At a median follow-up of 11.6 years, among individuals with elevated BP, there was a higher frequency of diabetes (elevated BP: adjusted relative risk [aRR] 1.88, 95% CI, 1.06-3.35; stage 1 hypertension: aRR 2.58, 95% CI, 1.62-4.10; stage 2 hypertension: aRR 2.83, 95% CI, 1.65-4.95) compared with those with normal BP. Among individuals with elevated BP, there was a higher frequency of elevated LDL cholesterol (elevated BP: aRR 1.27, 95% CI, 1.03-1.57; stage 1 hypertension: aRR 1.22, 95% CI, 1.02-1.45, and stage 2 hypertension: aRR 1.38, 95% CI, 1.10-1.74), elevated total cholesterol (elevated BP: aRR 1.27, 95% CI, 1.07-1.52; stage 1 hypertension: aRR 1.16, 95% CI, 1.00-1.35; stage 2 hypertension: aRR 1.41 95% CI, 1.16-1.71), and elevated triglycerides (elevated BP: aRR 2.24, 95% CI, 1.42-3.53; stage 1 hypertension: aRR 2.15, 95% CI, 1.46-3.17; stage 2 hypertension: aRR 3.24, 95% CI, 2.05-5.11) but not of low HDL cholesterol. CONCLUSION The frequency of adverse cardiometabolic outcomes at 10-14 years after delivery was progressively higher among pregnant individuals with BP greater than 120/80 in the early third trimester.
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Affiliation(s)
- Christine Field
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio; and the Department of Preventive Medicine and the Department of Medicine, Northwestern University, Chicago, Illinois
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Saxon CE, Bast J, Chou JC. Short and long-term complications of hypertensive disorders of pregnancy: lifelong cardiovascular risks we cannot ignore. Curr Opin Cardiol 2024; 39:259-265. [PMID: 38386339 DOI: 10.1097/hco.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW Hypertensive disorders of pregnancy (HDP) pose a significant threat to maternal cardiovascular health, with emerging research shedding light on the enduring risks beyond the gestational period. This review highlights updates regarding cardiovascular risks associated with HDP and their implications for long-term health. RECENT FINDINGS Patients with a history of HDP are at an elevated risk of developing chronic hypertension, ischemic heart disease, stroke, valvular heart disease, and heart failure.Not surprisingly, patients with HDP experience higher rates of maternal and fetal adverse events in the antepartum and immediate postpartum periods, with high readmission rates for cardiovascular complications. The high risk of chronic hypertension after a HDP then leads to the development of subclinical disease over 5-10 years with overt cardiovascular disease becoming most prevalent in the decades following pregnancy. Early hypertension management in the antepartum and postpartum periods has lifelong health benefits and highlights the need for seamless postpartum transitions with close blood pressure monitoring and cardiovascular risk mitigation. SUMMARY HDP significantly increases the risk of short and long-term adverse cardiovascular events. Integrated healthcare models that assess and address postpartum cardiovascular risk are necessary to improve the cardiovascular health and longevity of those effected by HDP.
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Affiliation(s)
| | - Julia Bast
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Schwarz EB, Begna H. Optimizing Postpartum Cardiovascular Health. J Womens Health (Larchmt) 2024; 33:848-850. [PMID: 38527249 DOI: 10.1089/jwh.2024.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Affiliation(s)
- Eleanor Bimla Schwarz
- UCSF Division of General Internal Medicine, Department of Medicine at San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Hannah Begna
- UCSF Division of General Internal Medicine, Department of Medicine at San Francisco General Hospital and Trauma Center, San Francisco, California, USA
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Scott J, Hauspurg A, Davis EM, Bryan S, Catov JM. Maternal Mental Health, COVID-19-Related Distress, and Disruptions in Lifestyle Behaviors Among Postpartum Mothers With a Previous Hypertensive Disorder of Pregnancy. J Cardiovasc Nurs 2024; 39:318-324. [PMID: 37723619 PMCID: PMC10948378 DOI: 10.1097/jcn.0000000000001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Many perinatal people experienced pandemic-related distress and changes in health behaviors at the onset of the COVID-19 pandemic, but less is known about how the pandemic continued to impact their health. OBJECTIVE The authors of this study examined the influence of pandemic-related distress and maternal mental health on postpartum lifestyle behaviors of mothers with a previous hypertensive disorder of pregnancy. METHODS Between September 2021 and March 2022, 82 postpartum (19.2 ± 5.5 months) mothers with a hypertensive disorder of pregnancy completed measures of pandemic-related distress and pandemic-related disruption in lifestyle behaviors from the Coronavirus Perinatal Experiences Impact Survey. A Patient Health Questionnaire-9 score ≥ 10 and a score ≥ 3 on the Breslau scale indicated significant depressive and posttraumatic stress disorder (PTSD) symptoms, respectively. RESULTS Twenty-two (27.2%) and 30 (36.6%) participants had significant depressive or PTSD symptoms, respectively. In models adjusted for education, income, parity, delivery prepandemic or peripandemic, intervention group, and prepregnancy mental health history, both PTSD symptoms ( B = 0.229, P = .029) and pandemic-related distress ( B = 0.492, P < .001) associated with greater disruption in health behaviors. Depressive symptoms did not associate with greater disruption in health behaviors ( B = 0.169, P = .135). CONCLUSION Monitoring PTSD symptoms may be vital in supporting mothers with hypertensive disorders of pregnancy in making lifestyle changes to prevent cardiovascular disease.
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Bucciarelli V, Moscucci F, Dei Cas A, Coppi F, Angeli F, Pizzi C, Renda G, Nodari S, Maffei S, Montisci R, Pedrinelli R, Sciomer S, Perrone Filardi P, Mattioli AV, Gallina S. Maternal-fetal dyad beyond the phenomenology of pregnancy: from primordial cardiovascular prevention on out, do not miss this boat! Curr Probl Cardiol 2024; 49:102695. [PMID: 38852910 DOI: 10.1016/j.cpcardiol.2024.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
Pregnancy represents a stress test for every woman's cardiovascular (CV) system, and a pre-existing maternal unfavorable cardio-metabolic phenotype can uncover both adverse pregnancy outcomes and the subsequent development of cardiovascular disease (CVD) risk factors during and after pregnancy. Moreover, the maternal cardiac and extracardiac environment can affect offspring's cardiovascular health through a complex mechanism called developmental programming, in which fetal growth can be influenced by maternal conditions. This interaction continues later in life, as adverse developmental programming, along with lifestyle risk factors and genetic predisposition, can exacerbate and accelerate the development of CV risk factors and CVD in childhood and adolescence. The aim of this narrative review is to summarize the latest evidences regarding maternal-fetal dyad and its role on primordial, primary and secondary CV prevention.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico n. 155, Rome 00161, Italy
| | - Alessandra Dei Cas
- Department of Medicine and Surgery, Università di Parma, Parma, Italy; Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca Coppi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, Bologna 40138, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences- DIMEC, University of Bologna, Via Giuseppe Massarenti 9, Bologna 40138, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia 25123, Italy
| | - Silvia Maffei
- Department of Cardiovascular Endocrinology and Metabolism, Gynaecological and Cardiovascular Endocrinology and Osteoporosis Unit, "Gabriele Monasterio" Foundation and Italian National Research Council (CNR) Pisa, Pisa 56124 Italy
| | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, 'Sapienza', Rome University, Viale dell'Università, 37, Rome 00185, Italy
| | | | - Anna Vittoria Mattioli
- Department of Quality of Life Sciences, University of Bologna-Alma Mater Studiorum, Bologna 40126, Italy.
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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Venkatesh KK, Khan SS, Yee LM, Wu J, McNeil R, Greenland P, Chung JH, Levine LD, Simhan HN, Catov J, Scifres C, Reddy U, Pemberton VL, Saade G, Bairey Merz CN, Grobman WB. Adverse Pregnancy Outcomes and Predicted 30-Year Risk of Maternal Cardiovascular Disease 2-7 Years After Delivery. Obstet Gynecol 2024; 143:775-784. [PMID: 38574364 PMCID: PMC11098696 DOI: 10.1097/aog.0000000000005569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To determine whether adverse pregnancy outcomes are associated with a higher predicted 30-year risk of atherosclerotic cardiovascular disease (CVD; ie, coronary artery disease or stroke). METHODS This was a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. The exposures were adverse pregnancy outcomes during the first pregnancy (ie, gestational diabetes mellitus [GDM], hypertensive disorder of pregnancy, preterm birth, and small- and large-for-gestational-age [SGA, LGA] birth weight) modeled individually and secondarily as the cumulative number of adverse pregnancy outcomes (ie, none, one, two or more). The outcome was the 30-year risk of atherosclerotic CVD predicted with the Framingham Risk Score assessed at 2-7 years after delivery. Risk was measured both continuously in increments of 1% and categorically, with high predicted risk defined as a predicted risk of atherosclerotic CVD of 10% or more. Linear regression and modified Poisson models were adjusted for baseline covariates. RESULTS Among 4,273 individuals who were assessed at a median of 3.1 years after delivery (interquartile range 2.5-3.7), the median predicted 30-year atherosclerotic CVD risk was 2.2% (interquartile range 1.4-3.4), and 1.8% had high predicted risk. Individuals with GDM (least mean square 5.93 vs 4.19, adjusted β=1.45, 95% CI, 1.14-1.75), hypertensive disorder of pregnancy (4.95 vs 4.22, adjusted β=0.49, 95% CI, 0.31-0.68), and preterm birth (4.81 vs 4.27, adjusted β=0.47, 95% CI, 0.24-0.70) were more likely to have a higher absolute risk of atherosclerotic CVD. Similarly, individuals with GDM (8.7% vs 1.4%, adjusted risk ratio [RR] 2.02, 95% CI, 1.14-3.59), hypertensive disorder of pregnancy (4.4% vs 1.4%, adjusted RR 1.91, 95% CI, 1.17-3.13), and preterm birth (5.0% vs 1.5%, adjusted RR 2.26, 95% CI, 1.30-3.93) were more likely to have a high predicted risk of atherosclerotic CVD. A greater number of adverse pregnancy outcomes within the first birth was associated with progressively greater risks, including per 1% atherosclerotic CVD risk (one adverse pregnancy outcome: 4.86 vs 4.09, adjusted β=0.59, 95% CI, 0.43-0.75; two or more adverse pregnancy outcomes: 5.51 vs 4.09, adjusted β=1.16, 95% CI, 0.82-1.50), and a high predicted risk of atherosclerotic CVD (one adverse pregnancy outcome: 3.8% vs 1.0%, adjusted RR 2.33, 95% CI, 1.40-3.88; two or more adverse pregnancy outcomes: 8.7 vs 1.0%, RR 3.43, 95% CI, 1.74-6.74). Small and large for gestational age were not consistently associated with a higher atherosclerotic CVD risk. CONCLUSION Individuals who experienced adverse pregnancy outcomes in their first birth were more likely to have a higher predicted 30-year risk of CVD measured at 2-7 years after delivery. The magnitude of risk was higher with a greater number of adverse pregnancy outcomes experienced.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University (Columbus, OH)
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University (Chicago, IL)
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University (Chicago, IL)
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University (Columbus, OH)
| | | | - Philip Greenland
- Department of Preventive Medicine, Northwestern University (Chicago, IL)
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine (Orange, CA)
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania (Philadelphia, PA)
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh (Pittsburgh, PA)
| | - Janet Catov
- Department of Obstetrics and Gynecology, University of Pittsburgh (Pittsburgh, PA)
| | - Christina Scifres
- Department of Obstetrics and Gynecology, Indiana University (Indianapolis, IN)
| | - Uma Reddy
- Department of Obstetrics and Gynecology, Columbia University (New York, NY)
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Insititues of Health (Bethesda, MD)
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical College (Norfolk, VA)
| | - C Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars Sinai Medical Center (Los Angeles, CA)
| | - William B Grobman
- Department of Obstetrics and Gynecology, The Ohio State University (Columbus, OH)
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Venkatesh KK, Khan SS, Catov J, Wu J, McNeil R, Greenland P, Wu J, Levine LD, Yee LM, Simhan HN, Haas DM, Reddy UM, Saade G, Silver RM, Merz CNB, Grobman WA. Socioeconomic disadvantage in pregnancy and postpartum risk of cardiovascular disease. Am J Obstet Gynecol 2024:S0002-9378(24)00589-1. [PMID: 38759711 DOI: 10.1016/j.ajog.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Pregnancy is an educable and actionable life stage to address social determinants of health (SDOH) and lifelong cardiovascular disease (CVD) prevention. However, the link between a risk score that combines multiple neighborhood-level social determinants in pregnancy and the risk of long-term CVD remains to be evaluated. OBJECTIVE To examine whether neighborhood-level socioeconomic disadvantage measured by the Area Deprivation Index (ADI) in early pregnancy is associated with a higher 30-year predicted risk of CVD postpartum, as measured by the Framingham Risk Score. STUDY DESIGN An analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. Participant home addresses during early pregnancy were geocoded at the Census-block level. The exposure was neighborhood-level socioeconomic disadvantage using the 2015 ADI by tertile (least deprived [T1], reference; most deprived [T3]) measured in the first trimester. Outcomes were the predicted 30-year risks of atherosclerotic cardiovascular disease (ASCVD, composite of fatal and nonfatal coronary heart disease and stroke) and total CVD (composite of ASCVD plus coronary insufficiency, angina pectoris, transient ischemic attack, intermittent claudication, and heart failure) using the Framingham Risk Score measured 2 to 7 years after delivery. These outcomes were assessed as continuous measures of absolute estimated risk in increments of 1%, and, secondarily, as categorical measures with high-risk defined as an estimated probability of CVD ≥10%. Multivariable linear regression and modified Poisson regression models adjusted for baseline age and individual-level social determinants, including health insurance, educational attainment, and household poverty. RESULTS Among 4309 nulliparous individuals at baseline, the median age was 27 years (interquartile range [IQR]: 23-31) and the median ADI was 43 (IQR: 22-74). At 2 to 7 years postpartum (median: 3.1 years, IQR: 2.5, 3.7), the median 30-year risk of ASCVD was 2.3% (IQR: 1.5, 3.5) and of total CVD was 5.5% (IQR: 3.7, 7.9); 2.2% and 14.3% of individuals had predicted 30-year risk ≥10%, respectively. Individuals living in the highest ADI tertile had a higher predicted risk of 30-year ASCVD % (adjusted ß: 0.41; 95% confidence interval [CI]: 0.19, 0.63) compared with those in the lowest tertile; and those living in the top 2 ADI tertiles had higher absolute risks of 30-year total CVD % (T2: adj. ß: 0.37; 95% CI: 0.03, 0.72; T3: adj. ß: 0.74; 95% CI: 0.36, 1.13). Similarly, individuals living in neighborhoods in the highest ADI tertile were more likely to have a high 30-year predicted risk of ASCVD (adjusted risk ratio [aRR]: 2.21; 95% CI: 1.21, 4.02) and total CVD ≥10% (aRR: 1.35; 95% CI: 1.08, 1.69). CONCLUSION Neighborhood-level socioeconomic disadvantage in early pregnancy was associated with a higher estimated long-term risk of CVD postpartum. Incorporating aggregated SDOH into existing clinical workflows and future research in pregnancy could reduce disparities in maternal cardiovascular health across the lifespan, and requires further study.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH.
| | - Sadiya S Khan
- Departments of Preventive Medicine and Medicine, Northwestern University, Chicago, IL
| | - Janet Catov
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | | | - Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University, Chicago, IL
| | - Jun Wu
- Department of Environmental and Occupational Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Orange, CA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical College, Norfolk, VA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
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Feurdean M, Gittens-Williams L, Sous N, Malhotra R, Parikh A, Ravikumar V, Thomas P. Healthy Moms Clinic: Challenges and Opportunities of Integrating Postpartum Care Into Primary Care and Residency Education. Am J Public Health 2024; 114:S316-S317. [PMID: 38748965 PMCID: PMC11096757 DOI: 10.2105/ajph.2024.307595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Mirela Feurdean
- All authors are with Rutgers New Jersey Medical School, Newark
| | | | - Natalie Sous
- All authors are with Rutgers New Jersey Medical School, Newark
| | | | - Aashka Parikh
- All authors are with Rutgers New Jersey Medical School, Newark
| | | | - Pauline Thomas
- All authors are with Rutgers New Jersey Medical School, Newark
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11
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Cameron NA, Birdsell H, Niznik CM, Michon R, Donelan E, Yee LM, Dolan BM. An Enhanced Postpartum Transition Program to Primary Care. J Womens Health (Larchmt) 2024. [PMID: 38634543 DOI: 10.1089/jwh.2023.0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are risk factors for future cardiovascular disease, yet few individuals receive postpartum care with primary care clinicians (PCP). To facilitate transitions of care to PCPs and improve cardiovascular health monitoring within the first 13 months postpartum, we developed and piloted an enhanced postpartum referral pathway for patients with GDM or HDP. Methods: Eligible patients included those who received perinatal care at a large, urban, academic medical center, experienced GDM or HDP during their most recent pregnancy, and lacked an existing PCP. Resident, faculty, and advanced practitioners referred patients during antenatal, delivery-related, or postpartum visits. A dedicated scheduler contacted patients to schedule an appointment with a women's health-focused resident or faculty PCP. The percent of patients who attended a postpartum PCP visit, who had an HbA1c and cholesterol panel checked within the first 13 months postpartum, were compared between patients referred and not referred to the program using adjusted odds ratios (aOR). Results: Of 129 individuals referred, 48.1% attended a PCP visit, 31.8% completed cholesterol screening, and 41.9% completed HbA1c screening within 13 months postpartum. After adjusting for age, parity, insurance, and referral indication, referred individuals had greater odds for each outcome (PCP visit: aOR = 6.0, 95% CI 4.0-9.0; cholesterol: aOR = 2.4, 95% 1.6-3.9; HbA1c: aOR = 2.5, 95% CI 1.7-3.7) compared with nonreferred individuals in the same time period. Discussion: A enhanced postpartum PCP referral pathway pilot for birthing individuals was associated with improved follow-up in the first year postpartum.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Heather Birdsell
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charlotte M Niznik
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ruth Michon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Donelan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Dartmouth University, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brigid M Dolan
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Wang R, Zhao J, Li L, Huo Y. Associations between lipid-lowering drugs and pregnancy and perinatal outcomes: a Mendelian randomization study. J Hypertens 2024; 42:727-734. [PMID: 38230624 DOI: 10.1097/hjh.0000000000003664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Mounting evidence has indicated that maternal dyslipidemia is associated with adverse obstetric outcomes, and the actions of lipid-lowering drugs in pregnant women remain controversial. Hence, this study aimed to appraise the causal relationship of lipid-lowering drugs [hydroxymethylglutaryl-coenzyme reductase (HMGCR) inhibitors, PCSK9 inhibitors, and NPC1L1 inhibitors] with pregnancy and perinatal outcomes using drug-targeting Mendelian randomization analysis. METHODS As a proxy for lipid-lowering drug exposure, two genetic instruments were used: genetic variants within or near the gene linked to low-density lipoprotein cholesterol (LDL-C) and the expression of quantitative trait loci of the drug target gene. Effect estimates were calculated using the inverse variance weighting (IVW) method and summary data-based Mendelian randomization (SMR) method. Heterogeneity and pleiotropy were assessed by Mendelian randomization-Egger regression, the Cochran Q test, and MR-PRESSO analysis. RESULTS HMGCR inhibitors were ascribed to a reduced risk of preeclampsia in both the IVW-MR method [odds ratio (OR) 0.583; 95% confidence interval (CI) 0.418-0.812; P = 0.001] and SMR analysis (OR 0.816; 95% CI 0.675-0.986; P = 0.036). The causal link between HMGCR inhibitors and offspring birthweight was statistically significant only in the analysis using the IVW method (OR, 0.879; 95% CI, 0.788-0.980; P = 0.020), and the combined results of the OR values supported the potential inhibitory effect of HMGCR inhibitors on offspring birthweight. Causal associations between lipid-lowering drugs and gestational diabetes, preterm birth, and congenital anomalies were not detected in either analysis. CONCLUSION No causal associations were observed between lipid-lowering drugs and gestational diabetes, preterm birth or congenital anomalies, whereas genetically predicted HMGCR inhibition dramatically reduced the risk of preeclampsia but attenuated offspring birthweight.
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Affiliation(s)
- Runfang Wang
- Department of Obstetrics and Gynecology, Hebei General Hospital, Hebei, China
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13
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Ananth CV, Lee R, Valeri L, Ross Z, Graham HL, Khan S, Cabrera J, Rosen T, Kostis WJ. Placental Abruption and Cardiovascular Event Risk (PACER): Design, data linkage, and preliminary findings. Paediatr Perinat Epidemiol 2024; 38:271-286. [PMID: 38273776 PMCID: PMC10978269 DOI: 10.1111/ppe.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Obstetrical complications impact the health of mothers and offspring along the life course, resulting in an increased burden of chronic diseases. One specific complication is abruption, a life-threatening condition with consequences for cardiovascular health that remains poorly studied. OBJECTIVES To describe the design and data linkage algorithms for the Placental Abruption and Cardiovascular Event Risk (PACER) cohort. POPULATION All subjects who delivered in New Jersey, USA, between 1993 and 2020. DESIGN Retrospective, population-based, birth cohort study. METHODS We linked the vital records data of foetal deaths and live births to delivery and all subsequent hospitalisations along the life course for birthing persons and newborns. The linkage was based on a probabilistic record-matching algorithm. PRELIMINARY RESULTS Over the 28 years of follow-up, we identified 1,877,824 birthing persons with 3,093,241 deliveries (1.1%, n = 33,058 abruption prevalence). The linkage rates for live births-hospitalisations and foetal deaths-hospitalisations were 92.4% (n = 2,842,012) and 70.7% (n = 13,796), respectively, for the maternal cohort. The corresponding linkage rate for the live births-hospitalisations for the offspring cohort was 70.3% (n = 2,160,736). The median (interquartile range) follow-up for the maternal and offspring cohorts was 15.4 (8.1, 22.4) and 14.4 (7.4, 21.0) years, respectively. We will undertake multiple imputations for missing data and develop inverse probability weights to account for selection bias owing to unlinked records. CONCLUSIONS Pregnancy offers a unique window to study chronic diseases along the life course and efforts to identify the aetiology of abruption may provide important insights into the causes of future CVD. This project presents an unprecedented opportunity to understand how abruption may predispose women and their offspring to develop CVD complications and chronic conditions later in life.
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Affiliation(s)
- Cande V. Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Rachel Lee
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Linda Valeri
- Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Inc., Ithaca, NY, USA
| | - Hillary L. Graham
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Clinical Epidemiology Division, Faculty of Medicine at Solna, Karolinska Institutet, Stockholm, Sweden
| | - Shama Khan
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Javier Cabrera
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Statistics, Rutgers University, Piscataway, NJ, USA
| | - Todd Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William J. Kostis
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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14
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Rosenberg EA, Seely EW. Long-term Cardiovascular Disease After Adverse Pregnancy Outcomes. J Clin Endocrinol Metab 2024; 109:e883-e891. [PMID: 37933906 DOI: 10.1210/clinem/dgad600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Indexed: 11/08/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among women. Adverse pregnancy outcomes (APOs) are cardiovascular risk factors that are unique to women and include gestational diabetes (GDM) and preeclampsia. While these risk factors emerge during the reproductive years and allow for early risk reduction counseling, they are often overlooked and not elicited by providers. This mini-review focuses primarily on GDM and preeclampsia, their relationship with CVD, mechanisms by which these conditions lead to CVD, and management, pharmacological and nonpharmacological, for the clinician who is caring for a woman with a history of an APO.
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Affiliation(s)
- Emily A Rosenberg
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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15
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Scott J, Hauspurg A, Muldoon MF, Davis EM, Catov JM. Neighborhood Deprivation, Perceived Stress, and Pregnancy-Related Hypertension Phenotypes a Decade Following Pregnancy. Am J Hypertens 2024; 37:220-229. [PMID: 37758228 PMCID: PMC10906066 DOI: 10.1093/ajh/hpad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/31/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy and other adverse pregnancy outcomes (APOs) increase the risk of developing chronic hypertension and cardiovascular disease. Perceptions of stress and neighborhood context also influence blood pressure (BP) fluctuations. We examined if APOs, higher perceived stress, and neighborhood deprivation were associated with hypertension phenotypes a decade after pregnancy in untreated individuals. METHODS Participants were 360 individuals who gave birth between 2008 and 2009 and participated in a research study 8-10 years following pregnancy. Standardized office and home BP readings were obtained, and we applied the AHA/ACC 2017 guidelines to identify sustained, white coat, and masked hypertension phenotypes. We measured personal stress with the perceived stress scale and neighborhood deprivation with the CDC Social Vulnerability Index. RESULTS Of the 38.3% (138/360) with any hypertension, 26.1% (36/138) reported a diagnosis of hypertension but were currently untreated. Sustained hypertension was the most common (17.8%), followed by masked and white coat hypertension, both 10.3%. Hypertensive disorders in pregnancy were associated with sustained (odds ratio [OR] 5.54 [95% confidence interval, CI 2.46, 12.46] and white coat phenotypes (OR 4.20 [1.66, 10.60], but not masked hypertension (OR 1.74 [0.62, 4.90]). Giving birth to a small for gestational age infant was also associated with sustained hypertension. In covariate adjusted models, perceived stress, but not neighborhood deprivation, was significantly associated with masked hypertension. CONCLUSIONS A decade after delivery, APOs were associated with sustained and white coat hypertension, but not masked hypertension. Exploration of the mechanisms underlying, and clinical implications of, these associations is warranted.
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Affiliation(s)
- Jewel Scott
- University of South Carolina College of Nursing, Columbia, South Carolina, USA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee Women’s Research Institute, Pittsburgh, Pennsylvania, USA
| | - Matthew F Muldoon
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esa M Davis
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Janet M Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Epidemiology and CTSI, University of Pittsburgh, Magee Women’s Research Institute, Pittsburgh, Pennsylvania, USA
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16
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Pfaller B, Busvine C, Rosenauer A, Schenzel A, Fournier C, Aringer I, Lösch A, Wiesholzer M, Schubert S, Wichert-Schmitt B. Knowledge and care regarding long-term cardiovascular risk after hypertensive disorders of pregnancy and gestational diabetes. Wien Klin Wochenschr 2024; 136:110-117. [PMID: 38170219 PMCID: PMC10837265 DOI: 10.1007/s00508-023-02313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Adverse pregnancy outcomes (APO), such as preeclampsia (PE) and gestational diabetes (GDM) are substantial risk factors for cardiovascular disease (CVD) later in life. Identifying these high-risk female individuals during pregnancy offers the possibility of preventing long-term CVD and chronic kidney disease via a structured therapeutic and surveillance plan. We aimed to evaluate the current practice of postpartum care in women after APO and the impact on the women's awareness about their future risk for CVD. METHODS Women diagnosed with PE and GDM at the University Hospital of St. Poelten/Lilienfeld between 2015-2020 were identified and participated in a structured telephone interview about postpartum medical care and knowledge about the impact of APOs on long-term cardiovascular health. RESULTS Of 161 out of the 750 women contacted, 29% (n = 46) were diagnosed with PE and 71% (n = 115) with GDM. One third of all women and up to 44% of women diagnosed with PE, were unaware that APOs are related to CVD. Women diagnosed with PE were less likely to receive postpartum care information than those with GDM (30.4% vs. 49.6%, p = 0.027), and only one third of all women after APOs were counselled by a physician or healthcare professional. Of the women 50% received recommendations regarding lifestyle changes after delivery; significantly more women with GDM than women with PE (54% vs. 37%, p = 0.05). Only 14% had at least one long-term follow-up. CONCLUSION This study identified a significant deficit of structured postpartum care and a lack of awareness among women after APO and their healthcare providers about the increased risk of long-term CVD.
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Affiliation(s)
- Birgit Pfaller
- Department of Internal Medicine 1, University Hospital of St. Pölten, Karl Landsteiner Institute for Nephrology, Karl Landsteiner University of Health Sciences, St. Pölten, Austria.
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria.
| | - Constance Busvine
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Alena Rosenauer
- Department of Internal Medicine 1, University Hospital of St. Pölten, Karl Landsteiner Institute for Nephrology, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Andreas Schenzel
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Camille Fournier
- Department of Internal Medicine 1, University Hospital of St. Pölten, Karl Landsteiner Institute for Nephrology, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Ida Aringer
- Department of Internal Medicine 1, University Hospital of St. Pölten, Karl Landsteiner Institute for Nephrology, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Alexander Lösch
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Gynecology and Obstetrics, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Martin Wiesholzer
- Department of Internal Medicine 1, University Hospital of St. Pölten, Karl Landsteiner Institute for Nephrology, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Susanne Schubert
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Gynecology and Obstetrics, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Barbara Wichert-Schmitt
- Department of Cardiology and Medical Intensive Care, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
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17
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Quansah DY, Lewis R, Savard K, Harris L, Visintini S, Coutinho T, Mullen KA. Cardiovascular Disease Risk Factor Interventions in Women With Prior Gestational Hypertensive Disorders or Diabetes in North America: A Rapid Review. CJC Open 2024; 6:153-164. [PMID: 38487059 PMCID: PMC10935679 DOI: 10.1016/j.cjco.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
Women with previous hypertensive disorders of pregnancy (HDP) or gestational diabetes mellitus (GDM) have a 2- to 3-fold increased risk of cardiovascular disease (CVD). The goal of this rapid review was to summarize evidence of the effectiveness of CVD risk factor interventions for postpartum women with a history of HDP or GDM. A comprehensive search strategy was used to search articles published in 5 databases-Ovid MEDLINE, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Embase). Observational and intervention studies that identified CVD prevention, screening, and/or risk factor management interventions among postpartum women with prior HDP or GDM in Canada and the US were included. The quality of observational and interventional studies, and their risk of bias, were assessed using appropriate critical appraisal checklists. Eight studies, including 4 observational cohorts, 3 randomized controlled trials, and 1 quasi-experimental study, merited inclusion for analysis. A total of 2449 participants were involved in the included studies. The most effective CVD risk factor intervention was comprised of postpartum transition and follow-up, CVD risk factor education, and advice on lifestyle changes. Most of the observational studies led to improvements in CVD risk factors, including improvements in CVD lifetime risk scores. However, none of the RCTs led to improvements in cardiometabolic risk factors. Few studies have investigated CVD risk factor interventions in the postpartum in women with previous HDP or GDM in North America. Further studies of higher quality are needed.
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Affiliation(s)
- Dan Yedu Quansah
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rebekah Lewis
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karine Savard
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Laura Harris
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerri-Anne Mullen
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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18
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Stuenkel CA. Reproductive milestones across the lifespan and cardiovascular disease risk in women. Climacteric 2024; 27:5-15. [PMID: 37769699 DOI: 10.1080/13697137.2023.2259793] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death for women across the developed and developing world. Beyond traditional cardiovascular risk factors, a number of reproductive milestones have been recognized. The goal of this White Paper, issued by the International Menopause Society in conjunction with World Menopause Day 2023, is to highlight female reproductive milestones in terms of potential cardiovascular risk and to review recommendations for minimizing that risk. The primary milestones discussed relate to menstrual cyclicity, adverse pregnancy outcomes, breast cancer treatments and menopause. Each of these categories has a number of permutations that have been shown in observational studies to be associated with increased cardiovascular risks. In current clinical care, recognition of these reproductive milestones has been encouraged so patients can be informed and motivated to engage in primary prevention of CVD early in their life course rather than retrospectively later in life. Options for specifically targeted care with specialist teams are designed to enhance success with risk identification, screening and possible detection of CVD and, optimally, primary or secondary prevention of CVD. Promoting cardiovascular health of women has far-reaching effects for themselves, their families and their progeny. It is time to make women's cardiovascular health a priority.
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Affiliation(s)
- C A Stuenkel
- Department of Medicine, Division of Endocrinology and Metabolism, UC San Diego School of Medicine, La Jolla, CA, USA
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19
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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Nicklas JM, Pyle L, Soares A, Leiferman JA, Bull SS, Tong S, Caldwell AE, Santoro N, Barbour LA. The Fit After Baby randomized controlled trial: An mHealth postpartum lifestyle intervention for women with elevated cardiometabolic risk. PLoS One 2024; 19:e0296244. [PMID: 38194421 PMCID: PMC10775990 DOI: 10.1371/journal.pone.0296244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Postpartum women with overweight/obesity and a history of adverse pregnancy outcomes are at elevated risk for cardiometabolic disease. Postpartum weight loss and lifestyle changes can decrease these risks, yet traditional face-to-face interventions often fail. We adapted the Diabetes Prevention Program into a theory-based mobile health (mHealth) program called Fit After Baby (FAB) and tested FAB in a randomized controlled trial. METHODS The FAB program provided 12 weeks of daily evidence-based content, facilitated tracking of weight, diet, and activity, and included weekly coaching and gamification with points and rewards. We randomized women at 6 weeks postpartum 2:1 to FAB or to the publicly available Text4baby (T4B) app (active control). We measured weight and administered behavioral questionnaires at 6 weeks, and 6 and 12 months postpartum, and collected app user data. RESULTS 81 eligible women participated (77% White, 2% Asian, 15% Black, with 23% Hispanic), mean baseline BMI 32±5 kg/m2 and age 31±5 years. FAB participants logged into the app a median of 51/84 (IQR 25,71) days, wore activity trackers 66/84 (IQR 43,84) days, logged weight 17 times (IQR 11,24), and did coach check-ins 5.5/12 (IQR 4,9) weeks. The COVID-19 pandemic interrupted data collection for the primary 12-month endpoint, and impacted diet, physical activity, and body weight for many participants. At 12 months postpartum women in the FAB group lost 2.8 kg [95% CI -4.2,-1.4] from baseline compared to a loss of 1.8 kg [95% CI -3.8,+0.3] in the T4B group (p = 0.42 for the difference between groups). In 60 women who reached 12 months postpartum before the onset of the COVID-19 pandemic, women randomized to FAB lost 4.3 kg [95% CI -6.0,-2.6] compared to loss in the control group of 1.3 kg [95% CI -3.7,+1.1] (p = 0.0451 for the difference between groups). CONCLUSIONS There were no significant differences between groups for postpartum weight loss for the entire study population. Among those unaffected by the COVID pandemic, women randomized to the FAB program lost significantly more weight than those randomized to the T4B program. The mHealth FAB program demonstrated a substantial level of engagement. Given the scalability and potential public health impact of the FAB program, the efficacy for decreasing cardiometabolic risk by increasing postpartum weight loss should be tested in a larger trial.
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Affiliation(s)
- Jacinda M. Nicklas
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Andrey Soares
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Jennifer A. Leiferman
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Sheana S. Bull
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Suhong Tong
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Ann E. Caldwell
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility & Reproductive Sciences, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Linda A. Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
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21
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Yan Q, Guerrero RF, Khan RR, Surujnarine AA, Wapner RJ, Hahn MW, Raja A, Salleb-Aouissi A, Grobman WA, Simhan H, Blue NR, Silver R, Chung JH, Reddy UM, Radivojac P, Pe’er I, Haas DM. Searching and visualizing genetic associations of pregnancy traits by using GnuMoM2b. Genetics 2023; 225:iyad151. [PMID: 37602697 PMCID: PMC10691790 DOI: 10.1093/genetics/iyad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Adverse pregnancy outcomes (APOs) are major risk factors for women's health during pregnancy and even in the years after pregnancy. Due to the heterogeneity of APOs, only few genetic associations have been identified. In this report, we conducted genome-wide association studies (GWASs) of 479 traits that are possibly related to APOs using a large and racially diverse study, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). To display extensive results, we developed a web-based tool GnuMoM2b (https://gnumom2b.cumcobgyn.org/) for searching, visualizing, and sharing results from a GWAS of 479 pregnancy traits as well as phenome-wide association studies of more than 17 million single nucleotide polymorphisms. The genetic results from 3 ancestries (Europeans, Africans, and Admixed Americans) and meta-analyses are populated in GnuMoM2b. In conclusion, GnuMoM2b is a valuable resource for extraction of pregnancy-related genetic results and shows the potential to facilitate meaningful discoveries.
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Affiliation(s)
- Qi Yan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Rafael F Guerrero
- Department of Computer Science, Indiana University, Bloomington, IN 47405, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Raiyan R Khan
- Department of Computer Science, Columbia University, New York, NY 10032, USA
| | - Andy A Surujnarine
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Matthew W Hahn
- Department of Computer Science, Indiana University, Bloomington, IN 47405, USA
- Department of Biology, Indiana University, Bloomington, IN 47405, USA
| | - Anita Raja
- Department of Computer Science, CUNY Hunter College, New York, NY 10065, USA
| | | | - William A Grobman
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Nathan R Blue
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA
| | - Robert Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA 92697, USA
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Predrag Radivojac
- Khoury College of Computer Sciences, Northeastern University, Boston, MA 02115, USA
| | - Itsik Pe’er
- Department of Computer Science, Columbia University, New York, NY 10032, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN 46202, USA
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22
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Wang W, Mu S, Yan W, Ke N, Cheng H, Ding R. Prenatal PM2.5 exposure increases the risk of adverse pregnancy outcomes: evidence from meta-analysis of cohort studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:106145-106197. [PMID: 37723397 DOI: 10.1007/s11356-023-29700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
Adverse pregnancy outcomes (APOs) are a significant cause of fetal death. A wide range of maternal psychological, social, and environmental factors may contribute to these outcomes. Mounting epidemiological studies have indicated that PM2.5 may result in these unfavorable consequences. Previously published meta-analyses have been updated and extended. Cohort studies were searched from three databases (up to July 24, 2023), and their quality was assessed by Newcastle-Ottawa Scale (NOS). Publication bias was examined by Egger's test and funnel plot. Despite a large number of studies showing similar results, the inconsistencies between these findings require careful generalization before concluding. This meta-analysis included 67 cohort studies from 20 countries, and the findings revealed that maternal PM2.5 exposure and five APOs were correlated significantly throughout pregnancy: preterm birth (PTB) (RR = 1.05; 95% CI: 1.03, 1.07); low birth weight (LBW) (RR = 1.02; 95% CI: 1.01, 1.04); small for gestational age (SGA) (RR = 1.03; 95% CI: 1.01, 1.04); stillbirth (RR = 1.24; 95% CI: 1.06, 1.45); and change in birthweight (weight change = -6.82 g; 95% CI: -11.39, -2.25). A positive association was found between APOs and PM2.5 exposure in this meta-analysis, and the degree of increased risk of APOs varied due to different gestation periods. Therefore, it is necessary to protect pregnant women at specific times.
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Affiliation(s)
- Wanrong Wang
- First School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Siqi Mu
- First School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Weizhen Yan
- First School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Naiyu Ke
- First School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Han Cheng
- First School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Rui Ding
- Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
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23
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Azizi Z, Adedinsewo D, Rodriguez F, Lewey J, Merchant RM, Brewer LC. Leveraging Digital Health to Improve the Cardiovascular Health of Women. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:205-214. [PMID: 37868625 PMCID: PMC10587029 DOI: 10.1007/s12170-023-00728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/24/2023]
Abstract
Purpose of Review In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women. Recent Findings Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care. Summary Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.
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Affiliation(s)
- Zahra Azizi
- Center for Digital Health, Stanford University, Stanford, CA USA
- Department of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA USA
| | | | - Fatima Rodriguez
- Department of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA USA
| | - Jennifer Lewey
- Department of Medicine, Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Raina M. Merchant
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN USA
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24
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Atkinson J, Simpson G, Walker SP, Tong S, Hastie R, Lindquist A. The long-term risk of cardiovascular disease among women with a history of hypertensive disorders of pregnancy: a systematic review of clinical practice guidelines. BMC Cardiovasc Disord 2023; 23:443. [PMID: 37689661 PMCID: PMC10492379 DOI: 10.1186/s12872-023-03446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/12/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND The lifelong risks of cardiovascular disease following preeclampsia and gestational hypertension are well-established. However, it is unclear whether this evidence has been translated into clinical practice guidelines. Thus, this review aimed to assess the quality and content of Australian clinical practice guidelines regarding the risk of cardiovascular disease following gestational hypertension and preeclampsia. METHODS We conducted a systematic search of MEDLINE (Ovid), EMBASE (Ovid), and CINAHL databases, as well as hospital, obstetric society, and medical college websites. Publications were included if: they were a clinical practice guideline; were published in the previous ten years; and included recommendations for the management of future cardiovascular disease risk following hypertensive disorders of pregnancy. Quality assessment was performed using Appraisal of Guidelines for Research and Evaluation Instrument Version Two (AGREE-II) and AGREE Recommendations Excellence Instrument (AGREE-REX). RESULTS Eighteen guidelines were identified, and of these, less than half (n = 8) included recommendations for managing future cardiovascular risk following hypertensive disorders of pregnancy. Across these eight, four main counselling recommendations were found regarding (1) risk of future cardiovascular disease; (2) risk factor screening; (3) lifestyle interventions; and (4) prenatal counselling for future pregnancies. The quality and content of these recommendations varied significantly, and the majority of guidelines (87.5%) were assessed as low to moderate quality. CONCLUSIONS There are limited Australian clinical practice guidelines providing appropriate advice regarding future risk of cardiovascular disease following hypertensive disorders of pregnancy. The quality and content of these guidelines varied significantly. These findings highlight the need for improved translation from evidence-based research to enhance clinical care and guidance.
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Affiliation(s)
- Jessica Atkinson
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Grace Simpson
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Anthea Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia.
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia.
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25
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Misra A, Porras MP, Rajendran A, Contreras J, Scott NS. Cardio-Obstetrics: A Focused Review. Curr Cardiol Rep 2023; 25:1065-1073. [PMID: 37540401 DOI: 10.1007/s11886-023-01928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the leading cause of maternal mortality in the USA. All cardiovascular care providers should have a foundational knowledge on the management of pregnant individuals with heart disease. This focused review touches on several key cardio-obstetric themes. RECENT FINDINGS Many individuals with cardiovascular disease can safely undergo pregnancy, but should have counseling preconception to optimize cardiac status. There are several cardiovascular conditions that are high risk for maternal mortality and morbidity. These individuals should be adequately counseled preconception and offered reliable birth control. The approach to a high-risk pregnant patient with cardiac disease is best managed by a multidisciplinary team to address potential maternal and fetal complications. Identification of at risk individuals can be estimated preconception with several risk scores. The development of risk scores to stratify and identify those at elevated risk during pregnancy is an area of continued research and development.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Aardra Rajendran
- Department of Internal Medicine, John Hopkins University, Baltimore, MD, USA
| | - Johanna Contreras
- Department of Cardiology, Division of Advanced Heart Failure and Transplant, Icahn School of Medicine, Mount Sinai, New York City, NY, USA
| | - Nandita S Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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26
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Aqua JK, Ford ND, Pollack LM, Lee JS, Kuklina EV, Hayes DK, Vaughan AS, Coronado F. Timing of outpatient postpartum care utilization among women with chronic hypertension and hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM 2023; 5:101051. [PMID: 37315845 PMCID: PMC10527898 DOI: 10.1016/j.ajogmf.2023.101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The postpartum period represents an opportunity to assess the cardiovascular health of women who experience chronic hypertension or hypertensive disorders of pregnancy. OBJECTIVE This study aimed to determine whether women with chronic hypertension or hypertensive disorders of pregnancy access outpatient postpartum care more quickly compared to women with no hypertension. STUDY DESIGN We used data from the Merative MarketScan Commercial Claims and Encounters Database. We included 275,937 commercially insured women aged 12 to 55 years who had a live birth or stillbirth delivery hospitalization between 2017 and 2018 and continuous insurance enrollment from 3 months before the estimated start of pregnancy to 6 months after delivery discharge. Using the International Classification of Diseases Tenth Revision Clinical Modification codes, we identified hypertensive disorders of pregnancy from inpatient or outpatient claims from 20 weeks gestation through delivery hospitalization and identified chronic hypertension from inpatient or outpatient claims from the beginning of the continuous enrollment period through delivery hospitalization. Distributions of time-to-event survival curves (time-to-first outpatient postpartum visit with a women's health provider, primary care provider, or cardiology provider) were compared between the hypertension types using Kaplan-Meier estimators and log rank tests. We used Cox proportional hazards models to estimate adjusted hazard ratios and 95% confidence intervals. Time points of interest (3, 6, and 12 weeks) were evaluated per clinical postpartum care guidelines. RESULTS Among commercially insured women, the prevalences of hypertensive disorders of pregnancy, chronic hypertension, and no documented hypertension were 11.7%, 3.4%, and 84.8%, respectively. The proportions of women with a visit within 3 weeks of delivery discharge were 28.5%, 26.4%, and 16.0% for hypertensive disorders of pregnancy, chronic, and no documented hypertension, respectively; by 12 weeks, the proportions increased to 62.4%, 64.5%, and 54.2%, respectively. Kaplan-Meier analyses indicated significant differences in utilization by hypertension type and interaction between hypertension type, and time before and after 6 weeks. In adjusted Cox proportional hazards models, the utilization rate before 6 weeks among women with hypertensive disorders of pregnancy was 1.42 times the rate for women with no documented hypertension (adjusted hazard ratio, 1.42; 95% confidence interval, 1.39-1.45). Women with chronic hypertension also had higher utilization rates compared to women with no documented hypertension before 6 weeks (adjusted hazard ratio, 1.28; 95% confidence interval, 1.24-1.33). Only chronic hypertension was significantly associated with utilization compared to the no documented hypertension group after 6 weeks (adjusted hazard ratio, 1.09; 95% confidence interval, 1.03-1.14). CONCLUSION In the 6 weeks following delivery discharge, women with hypertensive disorders of pregnancy and chronic hypertension attended outpatient postpartum care visits sooner than women with no documented hypertension. However, after 6 weeks this difference extended only to women with chronic hypertension. Overall, postpartum care utilization remained around 50% to 60% by 12 weeks in all groups. Addressing barriers to postpartum care attendance can ensure timely care for women at high risk for cardiovascular disease.
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Affiliation(s)
- Jasmine Ko Aqua
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (Ms Aqua)
| | - Nicole D Ford
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (Ms Aqua, Drs Pollack, Lee, Kuklina, Hayes, Vaughan, and Coronado); Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA (Dr Ford)
| | - Lisa M Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (Ms Aqua, Drs Pollack, Lee, Kuklina, Hayes, Vaughan, and Coronado)
| | - Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (Ms Aqua, Drs Pollack, Lee, Kuklina, Hayes, Vaughan, and Coronado)
| | - Elena V Kuklina
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (Ms Aqua, Drs Pollack, Lee, Kuklina, Hayes, Vaughan, and Coronado)
| | - Donald K Hayes
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (Ms Aqua, Drs Pollack, Lee, Kuklina, Hayes, Vaughan, and Coronado)
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (Ms Aqua, Drs Pollack, Lee, Kuklina, Hayes, Vaughan, and Coronado).
| | - Fátima Coronado
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (Ms Aqua, Drs Pollack, Lee, Kuklina, Hayes, Vaughan, and Coronado)
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27
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Fraser A, Catov JM. Placental syndromes and long-term risk of hypertension. J Hum Hypertens 2023; 37:671-674. [PMID: 36702879 PMCID: PMC10403351 DOI: 10.1038/s41371-023-00802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/28/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
Higher blood pressure prior to pregnancy is associated with increased risk of placental abruption, hypertension and preeclampsia, preterm delivery and fetal growth restriction. These conditions are jointly termed placental syndromes as they are characterised by impaired placentation and early placental vascularization. Placental syndromes are associated with an increased maternal risk of progression to hypertension and cardiovascular disease (CVD) in later life. Women affected by both a clinical placental syndrome and with evidence of placental maternal vascular malperfusion (MVM) have a particularly high risk of hypertension and CVD. Yet whether placental impairment and clinical syndromes are causes or consequences of higher blood pressure in women remains unclear. In this review, we address the relationship between blood pressure and maternal health in pregnancy. We conclude that there is a pressing need for studies with a range of detailed measures of cardiac and vascular structure and function taken before, during and after pregnancy to solve the 'chicken and egg' puzzle of women's blood pressure and pregnancy health, and to inform effective precision medicine prevention and treatment of both placental syndromes and chronic hypertension in women.
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Affiliation(s)
- Abigail Fraser
- Population Health Sciences, Bristol Medical School and the MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
| | - Janet M Catov
- Department of Obstetrics, Gynaecology and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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28
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Errors in Funding/Support. JAMA Cardiol 2023; 8:797. [PMID: 37314771 PMCID: PMC10267843 DOI: 10.1001/jamacardio.2023.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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29
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Cameron NA, Yee LM, Dolan BM, O'Brien MJ, Greenland P, Khan SS. Trends in Cardiovascular Health Counseling Among Postpartum Individuals. JAMA 2023; 330:359-367. [PMID: 37490084 PMCID: PMC10369213 DOI: 10.1001/jama.2023.11210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Importance Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals. Objective To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit. Design, Setting, and Participants Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]). Exposures Total number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs). Main Outcomes and Measures Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year. Results From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, -1.4% [95% CI, -1.8% to -1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, -0.7% [95% CI, -1.3% to -0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, -0.8% [95% CI, -1.3% to -0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors. Conclusions and Relevance Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.
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Affiliation(s)
- Natalie A Cameron
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M Yee
- Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois
| | - Brigid M Dolan
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J O'Brien
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Philip Greenland
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Guan C, Rodriguez C, Elder-Odame P, Minhas AS, Zahid S, Baker VL, Shufelt CL, Michos ED. Assisted reproductive technology: what are the cardiovascular risks for women? Expert Rev Cardiovasc Ther 2023; 21:663-673. [PMID: 37779500 PMCID: PMC10615881 DOI: 10.1080/14779072.2023.2266355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/29/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Infertility affects 15% of women of reproductive age in the United States. The use of assisted reproductive technology (ART) has been rising globally, as well as a growing recognition of reproductive factors that increase risk for cardiovascular disease (CVD). AREAS COVERED Women with infertility who use ART are more likely to have established CVD risk factors, such as obesity, dyslipidemia, hypertension, and diabetes. They are also more likely to experience adverse pregnancy outcomes, which are associated with both peripartum and long-term cardiovascular complications. ART may lead to increased cardiometabolic demands due to ovarian stimulation, pregnancy itself, and higher rates of multifetal gestation. Preeclampsia risk appears greater with frozen rather than fresh embryo transfers. EXPERT OPINION The use of ART and its association with long term CVD has not been well-studied. Future prospective and mechanistic studies investigating the association of ART and CVD risk may help determine causality. Nevertheless, CVD risk screening is critical pre-pregnancy and during pregnancy to reduce pregnancy complications that elevate future CVD risk. This also offers a window of opportunity to connect patients to longitudinal care for early management of cardiometabolic risk profile and initiation of preventive lifestyle and pharmacotherapy interventions tailored toward patient-specific risk factors.
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Affiliation(s)
- Carolyn Guan
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carla Rodriguez
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Petal Elder-Odame
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Anum S. Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Salman Zahid
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Valerie L. Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine
| | | | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women's Lifespan: An Updated Review. J Clin Med 2023; 12:4347. [PMID: 37445383 DOI: 10.3390/jcm12134347] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women's lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- National Institute for Cardiovascular Research-INRC, 40126 Bologna, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
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Yan Q, Guerrero RF, Khan RR, Surujnarine AA, Wapner RJ, Hahn MW, Raja A, SallebAouissi A, Grobman WA, Simhan H, Blue NR, Silver R, Chung JH, Reddy UM, Radivojac P, Pe'er I, Haas DM. Searching and visualizing genetic associations of pregnancy traits by using GnuMoM2b. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.25.23290500. [PMID: 37333377 PMCID: PMC10274999 DOI: 10.1101/2023.05.25.23290500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Adverse pregnancy outcomes (APOs) are major risk factors for women's health during pregnancy and even in the years after pregnancy. Due to the heterogeneity of APOs, only few genetic associations have been identified. In this report, we conducted genome-wide association studies (GWAS) of 479 traits that are possibly related to APOs using a large and racially diverse study, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). To display the extensive results, we developed a web-based tool GnuMoM2b ( https://gnumom2b.cumcobgyn.org/ ) for searching, visualizing, and sharing results from GWAS of 479 pregnancy traits as well as phenome-wide association studies (PheWAS) of more than 17 million single nucleotide polymorphisms (SNPs). The genetic results from three ancestries (Europeans, Africans, and Admixed Americans) and meta-analyses are populated in GnuMoM2b. In conclusion, GnuMoM2b is a valuable resource for extraction of pregnancy-related genetic results and shows the potential to facilitate meaningful discoveries.
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Cameron NA, Everitt IK, Lee KA, Yee LM, Khan SS. Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention. Hypertension 2023; 80:1162-1170. [PMID: 36960717 PMCID: PMC10192076 DOI: 10.1161/hypertensionaha.122.19317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Hypertension is a major, modifiable risk factor for cardiovascular disease (CVD) in the United States. Over the past decade, the prevalence of chronic hypertension (CHTN) during pregnancy has nearly doubled with persistent race- and place-based disparities. Blood pressure elevations are of particular concern during pregnancy given higher risk of maternal and fetal morbidity and mortality, as well as higher lifetime risk of CVD in birthing individuals with CHTN. When identified during pregnancy, CHTN can, therefore, serve as a lens into CVD risk, as well as a modifiable target to mitigate cardiovascular risk throughout the life course. Health services and public health interventions that equitably promote cardiovascular health during the peripartum period could have an important impact on preventing CHTN and reducing lifetime risk of CVD. This review will summarize the epidemiology and guidelines for the diagnosis and management of CHTN in pregnancy; describe the current evidence for associations between CHTN, adverse pregnancy outcomes, and CVD; and identify opportunities for peripartum care to equitably reduce hypertension and CVD risk throughout the life course.
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Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine (N.A.C.), Northwestern University Feinberg School of Medicine
| | - Ian K Everitt
- Department of Medicine, Division of Hospital Medicine (I.K.E.), Northwestern University Feinberg School of Medicine
| | - Kristen A Lee
- Department of Medicine, McGaw Medical Center of Northwestern University (K.A.L.)
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (L.M.Y.), Northwestern University Feinberg School of Medicine
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiology (S.S.K.), Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine (S.S.K.), Northwestern University Feinberg School of Medicine
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Alkhatib B, Salimi S, Jabari M, Padmanabhan V, Vyas AK. Impact of Adverse Gestational Milieu on Maternal Cardiovascular Health. Endocrinology 2023; 164:bqad060. [PMID: 37042476 PMCID: PMC10164662 DOI: 10.1210/endocr/bqad060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/13/2023]
Abstract
Cardiovascular disease affects 1% to 4% of the nearly 4 million pregnancies in the United States each year and is the primary cause of pregnancy-related mortality. Adverse pregnancy outcomes are associated with cardiovascular complications during pregnancy persisting into the postpartum period. Recently, investigations have identified an altered sex hormone milieu, such as in the case of hyperandrogenism, as a causative factor in the development of gestational cardiovascular dysfunction. The mechanisms involved in the development of cardiovascular disease in postpartum women are largely unknown. Animal studies have attempted to recapitulate adverse pregnancy outcomes to investigate causal relationships and molecular underpinnings of adverse gestational cardiac events and progression to the development of cardiovascular disease postpartum. This review will focus on summarizing clinical and animal studies detailing the impact of adverse pregnancy outcomes, including preeclampsia, gestational diabetes mellitus, and maternal obesity, on gestational cardiometabolic dysfunction and postpartum cardiovascular disease. Specifically, we will highlight the adverse impact of gestational hyperandrogenism and its potential to serve as a biomarker for maternal gestational and postpartum cardiovascular dysfunctions.
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Affiliation(s)
- Bashar Alkhatib
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA
| | - Shadi Salimi
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | - Mary Jabari
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | | | - Arpita Kalla Vyas
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA
- College of Human Medicine, California Northstate University, Elk Grove, CA 95757, USA
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O’Hara H, Taylor J, Woodside JV. The Association of Specific Dietary Patterns with Cardiometabolic Outcomes in Women with a History of Gestational Diabetes Mellitus: A Scoping Review. Nutrients 2023; 15:nu15071613. [PMID: 37049454 PMCID: PMC10097232 DOI: 10.3390/nu15071613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Gestational diabetes mellitus is associated with a significantly increased risk of later type 2 diabetes (T2DM) and cardiovascular disease (CVD). Post-natal interventions aim to reduce this risk by addressing diet and lifestyle factors and frequently focus on restricting energy or macronutrient intake. With increased interest in the role of complete dietary patterns in the prevention of cardiometabolic disease, we sought to evaluate what is known about the role of dietary patterns in reducing cardiometabolic risk in women with previous GDM. A systematic search was conducted to identify studies relating to dietary pattern and cardiometabolic parameters in women with a history of GDM. The search criteria returned 6014 individual studies. In total, 71 full texts were reviewed, with 24 studies included in the final review. Eleven individual dietary patterns were identified, with the Alternative Health Eating Index (AHEI), Mediterranean diet (MD), and low glycaemic index (GI) as the most commonly featured dietary patterns. Relevant reported outcomes included incident T2DM and glucose tolerance parameters, as well as several cardiovascular risk factors. Dietary patterns which have previously been extensively demonstrated to reduce the risk of cardiovascular and metabolic disorders in the general population, including AHEI, MD, and DASH, were found to be associated with a reduction in the incidence of T2DM, hypertension, and additional risk factors for cardiometabolic disease in women with a history of GDM. Notable gaps in the literature were identified, including the relationship between dietary patterns and incident CVD, as well as the relationship between a low GI diet and the development of T2DM in this population.
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Kim C, Catov J, Schreiner PJ, Appiah D, Wellons MF, Siscovick D, Calderon‐Margalit R, Huddleston H, Ebong IA, Lewis CE. Women's Reproductive Milestones and Cardiovascular Disease Risk: A Review of Reports and Opportunities From the CARDIA Study. J Am Heart Assoc 2023; 12:e028132. [PMID: 36847077 PMCID: PMC10111436 DOI: 10.1161/jaha.122.028132] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
In 1985 to 1986, the CARDIA (Coronary Artery Risk Development in Young Adults) study enrolled 5115 Black or White participants, including 2788 women, aged 18 to 30 years. Over the following 35 years, the CARDIA study amassed extensive longitudinal data on women's reproductive milestones, spanning menarche to menopause. Although not initially conceived as a study of women's health, >75 CARDIA study publications address relationships between reproductive factors and events with cardiovascular and metabolic risk factors, subclinical and clinical cardiovascular disease, and social determinants of health. The CARDIA study was one of the earliest population-based reports to note Black-White differences in age at menarche and associations with cardiovascular risk factors. Adverse pregnancy outcomes, particularly gestational diabetes and preterm birth, have been assessed along with postpartum behaviors, such as lactation. Existing studies have examined risk factors for adverse pregnancy outcomes and lactation, as well as their relationship to future cardiovascular and metabolic risk factors, diagnoses, and subclinical atherosclerosis. Ancillary studies examining components of polycystic ovary syndrome and ovarian biomarkers, such as anti-Müllerian hormone, have facilitated examination of reproductive health in a population-based cohort of young adult women. As the cohort transitioned through menopause, examination of the importance of premenopausal cardiovascular risk factors along with menopause has improved our understanding of shared mechanisms. The cohort is now aged in the 50s to mid-60s, and women will begin to experience a greater number of cardiovascular events as well as other conditions, such as cognitive impairment. Thus, in the next decade, the CARDIA study will provide a unique resource for understanding how the women's reproductive life course epidemiology informs cardiovascular risk, as well as reproductive and chronological aging.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine, Obstetrics and Gynecology, and EpidemiologyUniversity of MichiganAnn ArborMI
| | - Janet Catov
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPittsburghPA
| | - Pamela J. Schreiner
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMN
| | - Duke Appiah
- Department of Public Health, Graduate School of Biomedical SciencesTexas Tech UniversityLubbockTX
| | | | | | | | - Heather Huddleston
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCA
| | | | - Cora E. Lewis
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAL
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Ray JG, Cohen E, Butler EA, Grandi S, Park A. Indicators of Cardiometabolic Function in Pregnancy and Long-Term Risk of COVID-19: Population-Based Cohort Study. Cureus 2023; 15:e35325. [PMID: 36968929 PMCID: PMC10038685 DOI: 10.7759/cureus.35325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Pregnancy increases a woman's susceptibility to severe COVID-19, especially those with metabolic dysfunction. It is unknown if markers of metabolic dysfunction commonly assessed around pregnancy are associated with COVID-19 illness after pregnancy. AIM The aim of this study is to evaluate the indicators of metabolic dysfunction collected in pregnancy and the future risk of severe COVID-19 after pregnancy. METHODS This population-based cohort study was completed in all of Ontario, comprising 417,713 women aged 15-49 years with a hospital birth between April 2007 and March 2018. The main exposure was each 1-kg/m2 higher body mass index (BMI), 1-mmol/L higher glucose concentration at the 50-g glucose challenge test, and one-week earlier gestational week at delivery. The main outcome was severe COVID-19 illness or death, from the start of the pandemic period on March 1, 2020, till December 31, 2021. RESULTS The adjusted hazard ratio (aHR) of COVID-19 illness increased per 1-kg/m2 higher BMI (1.05, 95% CI 1.04-1.06), per 1-mmol/L higher serum glucose concentration (1.16, 95% CI 1.10-1.22), and for each one-week earlier gestational week at delivery (1.12, 95% CI 1.03-1.23). Relative to women with no dichotomized risk factors, the aHR for severe COVID-19 was 1.60 (95% CI 1.28-2.01) with one factor, 3.34 (95% CI 2.51-4.44) with two factors, and 4.52 (95% CI 2.11-9.67) with three factors. CONCLUSIONS The number, and degree, of standard metabolic indicators measured around pregnancy predict the future risk of severe COVID-19 remotely after that pregnancy.
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Khan SS, Brewer LC, Canobbio MM, Cipolla MJ, Grobman WA, Lewey J, Michos ED, Miller EC, Perak AM, Wei GS, Gooding H. Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e76-e91. [PMID: 36780391 PMCID: PMC10080475 DOI: 10.1161/cir.0000000000001124] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.
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Markers of Cardiovascular Risk Associated with Pregnancy. Curr Cardiol Rep 2023; 25:77-87. [PMID: 36745273 DOI: 10.1007/s11886-022-01830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize the unique cardiovascular disease (CVD) risk factors encountered during pregnancy and to provide the reader with a framework for acquiring a comprehensive obstetric history during the cardiovascular (CV) assessment of women. RECENT FINDINGS Individuals with a history of pregnancies complicated by hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm delivery, low birth weight, and fetal growth restriction during pregnancy are at a higher risk of developing short- and long-term CV complications compared to those without adverse pregnancy outcomes (APOs). Women with a history of APOs can be at increased risk of CVD even after achieving normoglycemia and normal blood pressure control postpartum. Risk assessment and stratification in women must account for these APOs as recommended by the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the primary prevention of CVD. Early recognition, monitoring, and treatment of APOs are key to limiting CVD complications late in maternal life. Recognition of APOs as female-specific cardiovascular risk factors is critical for risk stratification for women and birthing persons. Further research is needed to understand the complex interplay between genetics, environmental, behavioral, and maternal vascular health, and the association between APOs and CVD risk.
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Ramli I, Posadino AM, Giordo R, Fenu G, Fardoun M, Iratni R, Eid AH, Zayed H, Pintus G. Effect of Resveratrol on Pregnancy, Prenatal Complications and Pregnancy-Associated Structure Alterations. Antioxidants (Basel) 2023; 12:antiox12020341. [PMID: 36829900 PMCID: PMC9952837 DOI: 10.3390/antiox12020341] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Adverse pregnancy outcomes are considered significant health risks for pregnant women and their offspring during pregnancy and throughout their lifespan. These outcomes lead to a perturbated in-utero environment that impacts critical phases of the fetus's life and correlates to an increased risk of chronic pathological conditions, such as diabetes, obesity, and cardiovascular diseases, in both the mother's and adult offspring's life. The dietary intake of naturally occurring antioxidants promotes health benefits and disease prevention. In this regard, maternal dietary intake of polyphenolic antioxidants is linked to a reduced risk of maternal obesity and cardio-metabolic disorders, positively affecting both the fetus and offspring. In this work, we will gather and critically appraise the current literature highlighting the effect/s of the naturally occurring polyphenol antioxidant resveratrol on oxidative stress, inflammation, and other molecular and physiological phenomena associated with pregnancy and pregnancy conditions, such as gestational diabetes, preeclampsia, and preterm labor. The resveratrol impact on prenatal complications and pregnancy-associated structures, such as the fetus and placenta, will also be discussed. Finally, we will draw conclusions from the current knowledge and provide future perspectives on potentially exploiting resveratrol as a therapeutic tool in pregnancy-associated conditions.
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Affiliation(s)
- Iman Ramli
- Departement de Biologie Animale, Université des Frères Mentouri Constantine 1, Constantine 25000, Algeria
| | - Anna Maria Posadino
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Roberta Giordo
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Grazia Fenu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Manal Fardoun
- Department of Pharmacology and Toxicology, American University of Beirut, Beirut 11-0236, Lebanon
| | - Rabah Iratni
- Department of Biology, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| | - Ali H. Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha 2713, Qatar
| | - Hatem Zayed
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| | - Gianfranco Pintus
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence:
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Zahid S, Hashem A, Minhas AS, Bennett WL, Honigberg MC, Lewey J, Davis MB, Michos ED. Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004-2019). J Am Heart Assoc 2022; 11:e026786. [PMID: 36300664 PMCID: PMC9673632 DOI: 10.1161/jaha.122.026786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Gestational diabetes (GD) is associated with increased risk of long-term cardiovascular complications. However, data on acute peripartum cardiovascular complications are not well established. Hence, we aimed to investigate the association of GD with acute cardiovascular outcomes at the time of delivery admission. Methods and Results We used data from the National Inpatient Sample (2004-2019). International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10) codes were used to identify delivery hospitalizations and GD diagnosis. A total of 63 115 002 weighted hospitalizations for deliveries were identified, of which 3.9% were among individuals with GD (n=2 435 301). The prevalence of both GD and obesity increased during the study period (P trends<0.01). Individuals with GD versus those without GD had a higher prevalence of obesity, hypertension, and dyslipidemia. After adjustment for age, race or ethnicity, comorbidities, insurance, and income, GD remained independently associated with cardiovascular complications including preeclampsia (adjusted odds ratio [aOR], 1.97 [95% CI, 1.96-1.98]), peripartum cardiomyopathy (aOR, 1.15 [1.08-1.22]), acute kidney injury (aOR, 1.16 [1.11-1.21]), stroke (aOR, 1.15 [1.09-1.23]), and arrhythmias (aOR, 1.48 [1.46-1.50]), compared with no GD. Moreover, delivery hospitalizations among individuals with GD were associated with increased length (3 versus 2 days, P<0.01) and cost of hospitalization ($4909 versus $3682, P<0.01). Even in the absence of preeclampsia, GD was associated with elevated cardiovascular risk. Conclusions Individuals with GD had a higher risk of preeclampsia, peripartum cardiomyopathy, acute kidney injury, stroke, and arrhythmias during delivery hospitalizations. As rates of GD are increasing globally, efforts to improve preconception cardiometabolic health and prevent GD may represent important strategies to improve peripartum maternal outcomes and mitigate long-term cardiovascular risk.
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Affiliation(s)
- Salman Zahid
- Sands‐Constellation Heart Institute, Rochester General HospitalRochesterNY
| | - Anas Hashem
- Sands‐Constellation Heart Institute, Rochester General HospitalRochesterNY
| | - Anum S. Minhas
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - Wendy L. Bennett
- Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Michael C. Honigberg
- Cardiology Division, Department of MedicineMassachusetts General HospitalBostonMA
| | - Jennifer Lewey
- Division of Cardiology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | | | - Erin D. Michos
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
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Choi E, Kazzi B, Varma B, Ortengren AR, Minhas AS, Vaught AJ, Bennett WL, Lewey J, Michos ED. The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care. CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:219-229. [PMID: 36159207 PMCID: PMC9490714 DOI: 10.1007/s12170-022-00706-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/26/2023]
Abstract
Purpose of Review The "fourth trimester" concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women's cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester. Recent Findings A seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness. Summary Development of a comprehensive postpartum care plan with careful consideration of each patient's risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.
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Affiliation(s)
- Eunjung Choi
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, MD 21287 Baltimore, USA
| | - Bhavya Varma
- Department of Medicine, Johns Hopkins University School of Medicine, MD 21287 Baltimore, USA
| | | | - Anum S. Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287 USA
| | - Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
- Division of Cardiology, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD 21287 USA
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Ivey SL, Hanley HR, Taylor C, Stock E, Vora N, Woo J, Johnson S, Bairey Merz CN. Early identification and treatment of women's cardiovascular risk factors prevents cardiovascular disease, saves lives, and protects future generations: Policy recommendations and take action plan utilizing policy levers. Clin Cardiol 2022; 45:1100-1106. [PMID: 36128629 DOI: 10.1002/clc.23921] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular diseases (CVD) including heart attacks, strokes, heart failure, and uncontrolled hypertension are leading causes of death among women of all ages. Despite efforts to increase awareness about CVD among women, over the past decade there has been stagnation in the reduction of CVD in women, and CVD among younger women and women of color has in fact increased. We recommend taking action using policy levers to address CVD in women including: (1) Promoting periodic screening for risk factors including blood pressure, lipids/cholesterol, diabetes for all women starting at 18-21 years, with calculated atherosclerotic CVD (ASCVD) risk score use among women 40 years or older. (2) Considering coronary artery calcium (CAC) screening for those with intermediate risk per current guidelines. (3) Enhancing Obstetrics and Gynecology and primary care physician education on reproductive age CVD risk markers, and that follow-up is needed, including extended postpartum follow-up. (4) Offering Health Coaching/motivational Interviewing to support behavior change. (5) Funding demonstration projects using different care models. (6) Creating a Stop High Blood Pressure consult line (for providers and patients) and providing other support resources with actions consumers can take, modeled after the California tobacco quit line. And (7) Requiring inclusion of adverse pregnancy outcomes in all Electronic Health Records, with reminder systems to follow-up on hypertension post-partum.
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Affiliation(s)
- Susan L Ivey
- UC Berkeley, School of Public Health, Berkeley, California, USA
| | | | - Catrina Taylor
- California Department of Public Health, Sacramento, California, USA
| | - Eveline Stock
- UCSF, School of Medicine, Cardiology, San Francisco, California, USA
| | - Nirali Vora
- School of Medicine, Neurology, Stanford University, Stanford, California, USA
| | - Jenny Woo
- UC Berkeley, School of Public Health, Berkeley, California, USA
| | - Sara Johnson
- Obstetrics and Gynecology, Alta Bates Summit Medical Center, Berkeley, California, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
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Garr Barry V, Johnson TN, Herrick C, Lindley K, Carter EB. Adverse Pregnancy Outcomes and Postpartum Care as a Pathway to Future Health. Clin Obstet Gynecol 2022; 65:632-647. [PMID: 35708966 PMCID: PMC9339503 DOI: 10.1097/grf.0000000000000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Adverse pregnancy outcomes (APOs) collectively represent the leading causes of maternal and neonatal morbidity and mortality. Beyond the potentially devastating impact of APOs during pregnancy and the puerperium, women diagnosed with APOs have a 2-fold to 4-fold increased risk of future cardiovascular disease. Fortunately, APOs occur at an opportune time, in early-adulthood to mid-adulthood, when primary and secondary prevention strategies can alter the disease trajectory and improve long-term health outcomes. This chapter takes a life-course approach to (1) the epidemiology of APOs, (2) evidence-based strategies for clinicians to manage APOs, and (3) future directions for APO research and clinical practice.
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Affiliation(s)
- Valene Garr Barry
- Division of Clinical Research, Department of Obstetrics and Gynecology
| | - Traci N Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | | | - Ebony B Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis
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Mao Y, Hu W, Xia B, Liu L, Han X, Liu Q. Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases. Front Public Health 2022; 10:940335. [PMID: 35865249 PMCID: PMC9294140 DOI: 10.3389/fpubh.2022.940335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Gestational diabetes mellitus (GDM) has been linked to subsequent overall cardiovascular diseases. However, evidence on the associations of GDM with type-specific cardiovascular diseases is lacking, and findings on the potential impact of type 2 diabetes on the associations are not consistent. This study aimed to explore the associations between GDM and the risks of type-specific cardiovascular diseases. Methods Data were from 12,025 women (≥20 years) who had delivered at least one live birth in the National Health and Nutrition Examination Survey, 2007–2018. GDM history and type-specific cardiovascular diseases including coronary heart disease (CHD), heart failure and stroke were defined by self-report. We also combined our results with those from previously related publications on the associations between GDM and risks of type-specific cardiovascular diseases with a random-effect model. Results Compared with women without GDM, the multivariable-adjusted odds ratios (95% confidence intervals) were 1.82 (1.21–2.72) for CHD, 1.43 (0.80–2.53) for heart failure, and 1.19 (0.76–1.86) for stroke among women with a history of GDM. Type 2 diabetes was associated with 43.90, 67.44, and 63.16% of the excess odds of CHD, heart failure and stroke associated with GDM, respectively. Combining results from this study with those from previously related studies yielded odds ratios (95% confidence intervals) of 1.81 (1.60–2.05) for CHD (12 studies, 7,615,322 participants, I2= 72.6%), 1.66 (1.25–2.21) for heart failure (5 studies, 4,491,665 participants, I2= 88.6%), and 1.25 (1.07–1.46) for cerebrovascular disease (9 studies, 6,090,848 participants, I2= 77.8%). Conclusions GDM showed stronger associations with coronary heart diseases and heart failure than cerebrovascular disease, and the excess risks are attributable, in part, to type 2 diabetes.
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Affiliation(s)
- Yuanyuan Mao
- Department of Obstetrics and Gynecology, Suzhou Medical College of Soochow University, Suzhou, China
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Wenbin Hu
- Department of Chronic and Noncommunicable Disease Control and Preventions, The Kunshan Center for Disease Control and Prevention, Suzhou, China
| | - Bin Xia
- Department of Obstetrics and Gynecology, Suzhou Medical College of Soochow University, Suzhou, China
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Li Liu
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
| | - Xia Han
- Department of Administration, Maternal and Child Health Institution, Kunshan, China
| | - Qin Liu
- Department of Obstetrics and Gynecology, The First People's Hospital of Kunshan Affiliated With Jiangsu University, Suzhou, China
- *Correspondence: Qin Liu
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Chou JC. Hypertensive Disorders of Pregnancy and Cardiovascular Risk: We Are Missing the Opportunity of a Lifetime. J Am Coll Cardiol 2022; 79:2412-2414. [PMID: 35710192 DOI: 10.1016/j.jacc.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Josephine C Chou
- Yale University School of Medicine, New Haven, Connecticut, USA.
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Minhas AS, Goldstein SA, Vaught AJ, Lewey J, Ward C, Schulman SP, Michos ED. Instituting a Curriculum for Cardio-Obstetrics Subspecialty Fellowship Training. Methodist Debakey Cardiovasc J 2022; 18:14-23. [PMID: 35734150 PMCID: PMC9165665 DOI: 10.14797/mdcvj.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 01/26/2023] Open
Abstract
Maternal mortality is rising in the United States, and cardiovascular disease is the leading cause. Adverse pregnancy outcomes such as preeclampsia and gestational diabetes heighten the risk of cardiovascular complications during pregnancy and the peripartum period and are associated with long-term cardiovascular risks. The field of cardio-obstetrics is a subspecialty within adult cardiology that focuses on the management of women with or at high risk for heart disease who are considering pregnancy or have become pregnant. There is growing recognition of the need for more specialists with dedicated expertise in cardio-obstetrics to improve the cardiovascular care of this high-risk patient population. Current recommendations for cardiovascular fellowship training programs accredited by the Accreditation Council for Graduate Medical Education involve establishing core competency in the knowledge of managing heart disease in pregnancy. However, little granular detail is available of what such training should entail, which can lead to knowledge gaps. Additionally, dedicated advanced subspecialty training in this area is not commonly offered. Multidisciplinary collaborative teams have been shown to improve outcomes in cardiac patients during pregnancy, and cardiovascular fellows-in-training interested in cardio-obstetrics should have the opportunity to participate in and contribute to a pregnancy heart team. In this document, we describe a proposed specialized cardio-obstetrics training pathway that could serve to adequately prepare trainees to competently and comprehensively care for women with cardiovascular disease before, during, and after pregnancy.
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Affiliation(s)
- Anum S. Minhas
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US
| | | | | | - Jennifer Lewey
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - Cary Ward
- Duke University School of Medicine, Durham, North Carolina, US
| | | | - Erin D. Michos
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
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48
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Accelerated Coronary Atherosclerosis After Preeclampsia. J Am Coll Cardiol 2022; 79:2322-2324. [DOI: 10.1016/j.jacc.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022]
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Lewey J, Murphy S, Zhang D, Putt ME, Elovitz MA, Riis V, Patel MS, Levine LD. Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy: A Randomized Clinical Trial. JAMA Cardiol 2022; 7:591-599. [PMID: 35442393 PMCID: PMC9021982 DOI: 10.1001/jamacardio.2022.0553] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease, yet few interventions have targeted this population to decrease long-term risk. Objective To determine whether a digital health intervention improves physical activity in postpartum individuals with hypertensive disorders of pregnancy. Design, Setting, and Participants This 12-week randomized clinical trial enrolled postpartum individuals who delivered at the University of Pennsylvania and had a hypertensive disorder of pregnancy between October 2019 and June 2020. Analysis was intention to treat. Interventions All participants received a wearable activity tracker, established a baseline step count, selected a step goal greater than baseline, and were randomly assigned to control or intervention. Participants in the control arm received daily feedback on goal attainment. Participants in the intervention arm were placed on virtual teams and enrolled in a game with points and levels for daily step goal achievement and informed by principles of behavioral economics. Main Outcomes and Measures The primary outcome was change in mean daily step count from baseline to 12-week follow-up. Secondary outcome was proportion of participant-days that step goal was achieved. Results A total of 127 participants were randomized (64 in the control group and 63 in the intervention group) and were enrolled a mean of 7.9 weeks post partum. Participants had a mean (SD) age of 32.3 (5.6) years, 70 (55.1%) were Black, and 52 (41.9%) had Medicaid insurance. The mean (SD) baseline step count was similar in the control and intervention arms (6042 [2270] vs 6175 [1920] steps, respectively). After adjustment for baseline steps and calendar month, participants in the intervention arm had a significantly greater increase in mean daily step steps from baseline compared with the control arm (647 steps; 95% CI, 169-1124 steps; P = .009). Compared with the control arm, participants in the intervention arm achieved their steps goals on a greater proportion of participant-days during the intervention period (0.47 vs 0.38; adjusted difference 0.11; 95% CI, 0.04-0.19; P = .003). Conclusions and Relevance In this study, a digital health intervention using remote monitoring, gamification, and social incentives among postpartum individuals at elevated cardiovascular risk significantly increased physical activity throughout 12 weeks. Trial Registration ClinicalTrials.gov Identifier: NCT03311230.
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Affiliation(s)
- Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Samantha Murphy
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Dazheng Zhang
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mary E. Putt
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michal A. Elovitz
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Valerie Riis
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Lisa D. Levine
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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50
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O’Kelly AC, Michos ED, Shufelt CL, Vermunt JV, Minissian MB, Quesada O, Smith GN, Rich-Edwards JW, Garovic VD, El Khoudary SR, Honigberg MC. Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women. Circ Res 2022; 130:652-672. [PMID: 35175837 PMCID: PMC8870397 DOI: 10.1161/circresaha.121.319895] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman's reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.
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Affiliation(s)
- Anna C. O’Kelly
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chrisandra L. Shufelt
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jane V. Vermunt
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Margo B. Minissian
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA,Geri and Richard Brawerman Nursing Institute, Cedars-Sinai Medical Center, Los Angeles CA
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH,The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Graeme N. Smith
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
| | - Janet W. Rich-Edwards
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Samar R. El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Michael C. Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA,Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA
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