1
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Jones O, Ormesher L, Duhig KE, Peacock L, Myers JE. Pre-eclampsia and future cardiovascular disease risk: Assessing British clinicians' knowledge and practice. Pregnancy Hypertens 2024; 37:101145. [PMID: 39128383 DOI: 10.1016/j.preghy.2024.101145] [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: 09/17/2023] [Revised: 07/21/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE To explore UK-based clinicians' knowledge of long-term cardiovascular disease (CVD) risks after pre-eclampsia and capture current risk management practice. STUDY DESIGN A voluntary online survey was designed to explore clinicians' perception and management of CVD risks after pre-eclampsia. Distribution occurred May-July 2022 via social media and email. The survey assessed awareness of pre-eclampsia's association with future CVD, knowledge of published guidelines on CVD risk management after pre-eclampsia, and current practice of risk-reduction counselling. Results were analysed descriptively. MAIN OUTCOME MEASURE Clinician knowledge of postpartum cardiovascular risk and management following pre-eclampsia. RESULTS Of 240 respondents, 72 were midwives, 46 obstetricians, 8 cardiologists, and 114 general practitioners (GPs). Most clinicians knew that pre-eclampsia increases the risk of chronic hypertension (89 %) and stroke (75 %). Awareness was worse for heart failure (47 %) and peripheral vascular disease (55 %). Obstetricians provide CVD risk-reduction counselling to women with pre-eclampsia most frequently: 43 % always counsel and 27 % often counsel. Most other clinicians never counsel patients (midwives: 76 %, cardiologists: 75 %, GPs: 62 %). Most clinicians (84 %) were not aware of CVD risk management guidance after pre-eclampsia and 75 % of cardiologists and GPs never consider pre-eclampsia when assessing cardiovascular risk. Almost all clinicians (91 %) wished for greater education on the topic. CONCLUSIONS This study presents the first assessment of cardiovascular risk awareness after pre-eclampsia amongst UK-based clinicians. Although most knew pre-eclampsia increases CVD risk, patient counselling was limited. Targeted educational initiatives are needed to improve the knowledge-to-practice gap and reduce CVD prevalence after pre-eclampsia.
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Affiliation(s)
- Olivia Jones
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, United Kingdom.
| | - Laura Ormesher
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, United Kingdom; St Mary's Hospital, Manchester University NHS Foundation Trust, United Kingdom
| | - Kate E Duhig
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, United Kingdom; St Mary's Hospital, Manchester University NHS Foundation Trust, United Kingdom
| | - Linda Peacock
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, United Kingdom; St Mary's Hospital, Manchester University NHS Foundation Trust, United Kingdom
| | - Jenny E Myers
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, United Kingdom; St Mary's Hospital, Manchester University NHS Foundation Trust, United Kingdom
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2
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Brohan MP, Barrett PM. Hypertensive disorders of pregnancy: no longer just an "obstetrician's disease". Am J Obstet Gynecol 2024; 230:e32. [PMID: 37944840 DOI: 10.1016/j.ajog.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Matthew P Brohan
- School of Medicine, University College Cork, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland.
| | - Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
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3
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Garti I, Gray M, Bromley A, Tan JYB. Midwives' experiences of providing pre-eclampsia care in a low- and middle-income country - A qualitative study. Women Birth 2024; 37:332-339. [PMID: 37977957 DOI: 10.1016/j.wombi.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
PROBLEM Like other low- and middle-income countries, Ghana has high maternal mortality stemming from pre-eclampsia. Ghanaian midwives are frontline service providers of emergency care in obstetric complications and have the greatest potential to maximise pre-eclampsia outcomes. Little is known about the potential barriers and challenges to midwives' capacity to provide quality care in pre-eclampsia in Ghana. Therefore, we aimed to explore and gain insights into midwives' experiences of pre-eclampsia care including their knowledge, skills, and psychological aspects such as midwives' resilience. BACKGROUND There is a rising global incidence of pre-eclampsia. Quality midwifery care in inter-professional collaborative practice is crucial to reducing pre-eclampsia-related morbidity and mortality. METHODS A qualitative descriptive exploratory study. In-depth semi-structured interviews (n = 35) were performed in 2021 and analysed by thematic analysis. FINDINGS There were three main themes. 1) Competence and Confidence in care; midwives provided timely and appropriate care based on sound knowledge and skills; they explained how pre-eclampsia care was organised within a multidisciplinary context and described collaborative working amongst midwives for mutual learning and support. 2) Emotional concerns and empathy; midwives' described fulfillment in achieving positive pre-eclampsia outcomes. In contrast, maternal loss was distressing and traumatic. 3) Call for improved care resources for pre-eclampsia; midwives recommended expansion of continuing professional development opportunities, appropriate infrastructure, resources, tailored public education, and a review of pre-service education to support their participation in pre-eclampsia care. CONCLUSION To improve the quality of care in pre-eclampsia, midwives should be capacitated, systems should promptly address barriers, and prioritise midwives' emotional well-being.
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Affiliation(s)
- Isabella Garti
- Faculty of Health, Charles Darwin University, Darwin, Australia.
| | - Michelle Gray
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Angela Bromley
- Faculty of Health, Charles Darwin University, Darwin, Australia
| | - Jing-Yu Benjamin Tan
- Faculty of Health, Charles Darwin University, Darwin, Australia; School of Nursing and Midwifery, University of Southern Queensland, Ipswich Campus, Ipswich, QLD 4305, Australia
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4
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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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5
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Norris CM, Mullen KA, Foulds HJ, Jaffer S, Nerenberg K, Gulati M, Parast N, Tegg N, Gonsalves CA, Grewal J, Hart D, Levinsson AL, Mulvagh SL. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health. CJC Open 2024; 6:205-219. [PMID: 38487069 PMCID: PMC10935698 DOI: 10.1016/j.cjco.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 03/17/2024] Open
Abstract
Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Centre, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nazli Parast
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jasmine Grewal
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | | | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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6
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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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7
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Adreak N, Mackay MH, Pike A, O’Neill C, Sterling E, Randhawa V, Comber L, Thompson K, Srivaratharajah K, Paquin A, Abramson BL, Mullen KA. Integration of Women's Cardiovascular Health Content Into Healthcare Provider Education: Results of a Rapid Review and National Survey. CJC Open 2024; 6:463-472. [PMID: 38487051 PMCID: PMC10935693 DOI: 10.1016/j.cjco.2023.11.001] [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: 11/01/2023] [Indexed: 03/17/2024] Open
Abstract
Despite its importance, formal education in healthcare training programs on sex- and gender-specific cardiovascular disease (CVD) risk factors, symptoms, treatment, and outcomes is lacking. We completed rapid reviews of the academic and grey literature to describe the current state of women-specific CVD education in medical, nursing, and other healthcare education programs. Second, we analyzed results from a Canada-wide survey of healthcare professional education programs to identify gaps in curricula related to sex- and gender-specific training in CVD. Our academic review yielded only 15 peer-reviewed publications, and our online search only 20 healthcare education programs, that note that they specifically address women, or sex and gender, and CVD in their curricula. Across both searches, the majority of training and education programs were from the USA, varied greatly in length, delivery mode, and content covered, and lacked consistency in evaluation. Of surveys sent to 213 Canadian universities and other entry-to-practice programs, 80 complete responses (37.6%) were received. A total of 47 respondents (59%) reported that their programs included women-specific CVD content. Among those programs without content specific to CVD in women, 69.0% stated that its inclusion would add "quite a bit" or "a great deal" of value to the program. This study highlights the emerging focus on and substantial gaps in women-specific CVD training and education across healthcare education programs. All medical, nursing, and healthcare training programs are implored to incorporate sex- and gender-based CVD content into their regular curricula as part of a consolidated effort to minimize gaps in cardiovascular care.
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Affiliation(s)
- Najah Adreak
- Division Cardiac Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martha H. Mackay
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - April Pike
- Memorial University of Newfoundland Faculty of Nursing, St. John’s, Newfoundland and Labrador, Canada
| | - Carley O’Neill
- School of Kinesiology, Acadia University, Wolfville, Nova Scotia, Canada
| | - Evan Sterling
- Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Varinder Randhawa
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre; Department of Cardiology, St Michael’s Hospital; and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Comber
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Keshandi Thompson
- Canadian Women's Heart Health Alliance, University of Calgary, Calgary, Alberta, Canada
| | - Kajenny Srivaratharajah
- Division Cardiac Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amélie Paquin
- Institut universitaire de cardiologie et de pneumologie de Quebec—Universite Laval, Quebec City, Quebec, Canada
| | - Beth L. Abramson
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kerri-Anne Mullen
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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8
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Szakun N, Liva S, Bodner ME, Wolff A, Kim MY, Cote AT. Prevalence of Sex-Specific Cardiovascular Disease Risk Factors, Medical Risk, and Engagement in Health-Promoting Behaviours in Premenopausal Females. CJC Open 2024; 6:301-313. [PMID: 38487073 PMCID: PMC10935687 DOI: 10.1016/j.cjco.2023.11.003] [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: 08/11/2023] [Accepted: 11/04/2023] [Indexed: 03/17/2024] Open
Abstract
Background Several sex-specific risk factors (SS-RFs) increase a women's risk for cardiovascular disease (CVD) but are often overlooked during risk assessment. The purpose of this study was to identify the prevalence of SS-RFs and assess CVD risk, knowledge, perceptions and behaviours in premenopausal Canadian women. Methods An online survey was distributed across Canada to premenopausal biological females (19-49 years of age). The survey gathered demographics, medical history, engagement in health-promoting behaviours, and knowledge and perceptions of CVD risk. CVD risk was calculated using medical risk and SS-RFs were tabulated from medical history. Results A total of 2559 participants (33 ± 8 years) completed the survey. The majority of our sample (82%) was classified as low medical risk. Of those classified as low risk, 35% had at least 1 SS-RF. Of high-risk individuals, 70% underestimated their risk, 21% of whom perceived themselves as low risk. Engagement in health behaviours was suboptimal. Knowledge of traditional CVD risk factors and prevention was relatively high; however, less than one-half were aware of SS-RFs such as early menopause (39.4%). Conclusions Considering both traditional and SS-RFs, 47% of premenopausal Canadian women may be at risk for developing CVD. Of those deemed low medical risk for developing CVD, more than one-third reported having at least 1 SS-RF. Canadian women have poor knowledge of the risks associated with SS-RFs, lack sufficient awareness of the need for prevention of CVD, and are not engaging in sufficient health-promoting behaviours to mitigate future CVD risk.
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Affiliation(s)
- Natalie Szakun
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
| | - Sarah Liva
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Michael E. Bodner
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
| | - Angela Wolff
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Mi-Yeon Kim
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Anita T. Cote
- School of Human Kinetics, Trinity Western University, Langley, British Columbia, Canada
- Faculty of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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9
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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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10
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Kilkenny K, Frishman W. Preeclampsia's Cardiovascular Aftermath: A Comprehensive Review of Consequences for Mother and Offspring. Cardiol Rev 2024:00045415-990000000-00188. [PMID: 38189425 DOI: 10.1097/crd.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Preeclampsia (PE), a multisystem hypertensive disorder affecting 2-8% of pregnancies, has emerged as a novel risk factor for cardiovascular disease (CVD) in affected mothers and in their offspring. Between 10 and 15 years following gestation, women with a history of PE have double the risk of CVD, nearly 4 times the risk of hypertension, and increased all-cause mortality. Offspring exposed to PE in utero carry an increased risk of CVD and congenital heart defects. Due to the multifactorial nature of both PE and CVD, a clear dependency has been difficult to establish. The interplay between CVD and PE is an area of active investigation, likely involving placental, genetic, and epigenetic factors resulting in enduring endothelial, vascular, and immune dysfunction. Fetal developmental programming induced by adverse intrauterine environments, epigenetic changes triggered by oxidative stress, and underlying genetic predisposition play pivotal roles in the development of CVD in offspring exposed to PE. Though the literature has discussed the cardiovascular outcomes associated with PE for nearly a decade, patient risk perception and health care provider awareness remain low, representing a substantial missed opportunity for early intervention in this vulnerable population. This review article will discuss the pathophysiology of preeclampsia, its intersection with CVD, and the long-term cardiovascular consequences for affected mothers and their offspring. Our objective is to increase health care provider awareness and garner greater research interest in this important topic.
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Affiliation(s)
| | - William Frishman
- From the New York Medical College, School of Medicine, Valhalla, NY
- Department of Medicine, Westchester Medical Center, Valhalla, NY
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11
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Carcel C, Haupt S, Arnott C, Yap ML, Henry A, Hirst JE, Woodward M, Norton R. A life-course approach to tackling noncommunicable diseases in women. Nat Med 2024; 30:51-60. [PMID: 38242981 DOI: 10.1038/s41591-023-02738-1] [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: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
Women's health has been critically underserved by a failure to look beyond women's sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of death for women. Among these, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these conditions exist at each stage of women's lives, but recognition of the unique needs of women for the prevention and management of noncommunicable diseases is relatively recent and still emerging. Once they are diagnosed, treatments for these diseases are often costly and noncurative. Therefore, we call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic approach to women's health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational approach to advancing health equity for women, with ultimate benefits for society as a whole.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | - Sue Haupt
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Clare Arnott
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, South-West Sydney Local Health District, Sydney, New South Wales, Australia
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), South-Western Sydney Clinical School, Ingham Institute, UNSW, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Amanda Henry
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Discipline of Women's Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW, Sydney, New South Wales, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - Jane E Hirst
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Robyn Norton
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
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12
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Arntzen E, Jøsendal R, Sandsæter HL, Horn J. Postpartum follow-up of women with preeclampsia: facilitators and barriers - A qualitative study. BMC Pregnancy Childbirth 2023; 23:833. [PMID: 38049716 PMCID: PMC10694896 DOI: 10.1186/s12884-023-06146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Pregnancy causes physiological changes to the maternal organ systems that can be regarded as a cardiometabolic stress test for women. Preeclampsia, a pregnancy complication characterized by new onset of hypertension in combination with proteinuria or end-organ dysfunction, affects approximately 2-8% of pregnancies. Adverse pregnancy outcomes, including preeclampsia, have been described as a failed stress test and have been consistently linked with increased risk of cardiovascular disease later in life. The postpartum period is therefore often regarded as a window of opportunity for cardiovascular disease prevention. However, we lack knowledge about how women with preeclampsia experience current postpartum care in the Norwegian health system. The aim of this qualitative study is to uncover women's perspectives and preferences regarding postpartum follow-up. METHODS Semi-structured telephone interviews were conducted with 17 women following a six-month lifestyle intervention study. Participants were 9-20 months postpartum, following a pregnancy complicated by preeclampsia. Data were analyzed using Malterud's systematic text condensation. RESULTS We identified five themes, each with 2-3 subthemes, that demonstrate how women with recent preeclampsia experience postpartum follow-up: (1) fear and uncertainty (a body out of balance and facing an uncertain future), (2) a conversation on lifestyle - not really that difficult (preeclampsia as a gateway, a respectful approach, and a desire for more constructive feedback), (3) when your own health is not a priority (a new everyday life, out of focus, and lack of support), (4) motivation for lifestyle changes (an eye opener, lack of intrinsic motivation, and a helping hand), and (5) lack of structured and organized follow-up (there should be a proper system, a one-sided follow-up care, and individual variation in follow-up care). CONCLUSIONS Findings from this study highlight the need for more systematic postpartum follow-up for women after a pregnancy complicated by preeclampsia. Further research is required to explore the potential use of standardized guidelines and routine invitations to postpartum care. Furthermore, exploring health care professionals' experiences is crucial to ensure their engagement in postpartum care after complicated pregnancies.
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Affiliation(s)
- Eirin Arntzen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
| | - Ranveig Jøsendal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
| | - Heidi Linn Sandsæter
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Julie Horn
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway.
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
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13
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Mpalatsouka I, Zachariou M, Kyprianidou M, Fakonti G, Giannakou K. Assessing awareness of long-term health risks among women with a history of preeclampsia: a cross-sectional study. Front Med (Lausanne) 2023; 10:1236314. [PMID: 38020133 PMCID: PMC10662303 DOI: 10.3389/fmed.2023.1236314] [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: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Pregnancy complications, such as hypertensive disorders, present a substantial global public health challenge, with significant long-term implications for maternal and offspring health. This cross-sectional study aims to determine the level of awareness regarding long-term health risks among women who experienced preeclampsia during pregnancy in Cyprus and Greece. The study participants included adult women with a history of preeclampsia, while women with normal pregnancies were used as the comparison group. Data collection took place between June 2021 and February 2022, utilizing an online, self-administered questionnaire. The study included 355 women, with 139 (39.2%) in the preeclampsia group and 216 (60.8%) in the comparison group. Findings revealed that more than half of the women with prior preeclampsia (55.4%) were not aware of hypertensive disorders that can occur during pregnancy before their diagnosis, and a similar percentage (45.2%) had not received information about the long-term health risks following their diagnosis. Remarkably, only 3 participants (4.7%) with a history of preeclampsia were aware of the risk of developing cardiovascular diseases. There were no statistically significant differences between the preeclampsia and the comparison group regarding their concerns about long-term health risks, frequency of health checks, perceptions of factors influencing cardiovascular disease development, and doctor communication about different health topics, except from hypertension or high blood pressure. The study underscores the low level of awareness of long-term health risks among women with prior preeclampsia in Cyprus and Greece. This emphasizes the importance of implementing public health programs aimed at promoting cardiovascular risk assessment and effective management, both for clinicians and women with have experienced preeclampsia.
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Affiliation(s)
| | | | | | | | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
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14
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Hafskjold I, Rangul V, Ringvoll H, Kolberg M, Haug EB, Blomhoff R, Henriksen HB, Horn J. Postpartum Lifestyle Behaviors among Women with Hypertensive Disorders of Pregnancy: Data from the HUNT Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7025. [PMID: 37947581 PMCID: PMC10648747 DOI: 10.3390/ijerph20217025] [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: 09/15/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease later in life. Clinical guidelines for postpartum follow-up after HDP often recommend lifestyle counseling to reduce this risk. However, knowledge about lifestyle behaviors and perceptions among women with a history of HDP is limited. We linked data from the fourth survey of the population-based Trøndelag Health Study (HUNT4) with data from the Medical Birth Registry of Norway. The associations between HDP and postpartum lifestyle behaviors and perceptions were examined using multivariable logistic regression. In a secondary analysis, HUNT4 participants with a recent history of pre-eclampsia were compared with women with a recent history of pre-eclampsia participating in a postpartum pilot intervention study. Lifestyle behaviors and perceptions were self-reported and included diet (intake frequency of fruits, vegetables, meat, fish, and sugar-sweetened beverages), alcohol intake, physical activity, sleep, smoking, lifestyle satisfaction, and the importance of a healthy lifestyle. Among 7551 parous HUNT4 participants, 610 had a history of HDP. We found no differences in lifestyle behaviors between women with and without a history of HDP. However, women with HDP had higher odds of being unsatisfied with their lifestyle. Women with pre-eclampsia participating in a postpartum lifestyle intervention study tended to have a healthier lifestyle at baseline than women participating in HUNT4. Future studies should explore how lifestyle intervention programs could be adapted to the needs of women who have experienced HDP or other pregnancy complications that are associated with an increased risk of CVD.
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Affiliation(s)
- Ingrid Hafskjold
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Vegar Rangul
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, 7600 Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600 Levanger, Norway
| | - Hanne Ringvoll
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Marit Kolberg
- Center for Oral Health Services and Research Mid-Norway (TkMidt), 7030 Trondheim, Norway
| | - Eirin B. Haug
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0316 Oslo, Norway
- Department of Clinic Service, Division of Cancer Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Hege Berg Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0316 Oslo, Norway
| | - Julie Horn
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600 Levanger, Norway
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15
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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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Mahmoud Z, Orji AA, Okoye CF, Ameh FO, Jamro-Comer E, Isah A, Ekele B, Akaba G, Ojji DB, Huffman MD. Facilitators and barriers to optimal home blood pressure management in patients with hypertensive disorders of pregnancy in a tertiary care facility in Abuja, Nigeria: a qualitative research study. BMC Health Serv Res 2023; 23:954. [PMID: 37674174 PMCID: PMC10481544 DOI: 10.1186/s12913-023-09976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Nigeria has one of the highest burdens of maternal deaths globally, and hypertensive disorders of pregnancy (HDP) are the leading cause of maternal morbidity and mortality in the country. There is a significant implementation gap in utilizing evidence-based practices for the management of HDP in Nigeria. This study evaluated facilitators and barriers to implementing a home blood pressure monitoring program to improve management of HDP. METHODS From August 2022 to September 2022, we conducted 15 semi-structured, key informant interviews and 4 focus group discussions among patients, health care workers, and administrators at University of Abuja Teaching Hospital (UATH), a tertiary care centre in Nigeria. The study used the Consolidated Framework for Implementation Research to assess five domains: individual characteristics, inner and outer settings, intervention characteristics, and process of implementation. Audio files were transcribed, and data were analysed using a combination of inductive and deductive approaches. We also conducted 32 brief surveys on the participants to assess acceptability, appropriateness, and feasibility of a blood pressure monitoring program. RESULTS The study sample consisted of healthcare workers (n=22) including specialists in cardiology, obstetrics and gynaecology, maternal-foetal medicine, nurses/midwives and resident doctors as well as patients (n=10). Mean (SD) age was 39.5 (10.9), and 78% were female. Participants identified facilitators including the perceived simplicity of home blood pressure monitoring program, high burden of HDP, and availability of a multi-disciplinary team of healthcare professionals with expertise in HDP management. Barriers identified were cost, limited knowledge of HDP amongst patients, limited transportation networks, inconsistent management protocols, and inadequate manpower and facilities. Survey results indicated that between 81% and 88% of participants reported that a blood pressure monitoring program would be acceptable, 56%-72% reported that it would be appropriate, and 47%-69% reported that it would be feasible. CONCLUSION This study identified facilitators and barriers while highlighting key implementation strategies to leverage and effectively address these respectively to enable successful implementation of a home blood pressure monitoring program. It also demonstrated that a home blood pressure monitoring program was considered acceptable, appropriate and feasible among respondents interviewed at UATH.
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Affiliation(s)
- Zainab Mahmoud
- Washington University, 660 S Euclid Ave, Campus, Box 6068, St Louis, MO, 63110, USA.
| | - Adaego A Orji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Chukwuebuka F Okoye
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Friday O Ameh
- Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Erica Jamro-Comer
- Washington University, 660 S Euclid Ave, Campus, Box 6068, St Louis, MO, 63110, USA
| | - Aliyu Isah
- Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Bissallah Ekele
- Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Godwin Akaba
- Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Dike B Ojji
- Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Mark D Huffman
- Washington University, 660 S Euclid Ave, Campus, Box 6068, St Louis, MO, 63110, USA
- The George Institute for Global Health, Sydney, Australia
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17
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Silverio SA, Bye A, Hildersley R, Chingara O, Chang YS, Bick D. A longitudinal qualitative study of women's experiences of postnatal care following hypertensive disorders of pregnancy. Women Birth 2023; 36:460-468. [PMID: 36925402 DOI: 10.1016/j.wombi.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
PROBLEM There has been little focus on women's views of care and recovery following pregnancy complicated by hypertensive disorders of pregnancy [HDP] despite long-term implications for maternal health. BACKGROUND Increasingly in clinical research, areas of interest include the extent to which women are involved in postnatal care planning, perceived value of routine postnatal contacts, lifestyle behaviour advice, and extent to which ongoing concerns about HDP could be discussed with healthcare professionals. AIM This study explored women's experiences of birth-recovery up to 12 months following HDP. METHODS A longitudinal qualitative study using semi-structured interviews at four and 12 months postpartum. Twenty-four women who each had a form of HDP, were recruited using a maximum variation, purposive sampling strategy from four National Health Service maternity units in London, 21 of whom were interviewed at both time points. Data were collected and analysed by timepoint following a recurrent, cross-sectional cohort approach using template analysis methodology. FINDINGS Four main themes and ten sub-themes were identified. Main themes included: assumptions about blood pressure; perinatal experiences; postnatal care pathways; and managing complex health conditions. DISCUSSION Postnatal care needs to be tailored to women's individual needs following HDP, with ongoing review by relevant clinicians during and beyond the first six weeks. Many women with HDP have ongoing information needs about hypertensive status, treatment and prognoses, and future birth planning. CONCLUSION Policy makers, health providers and funders cannot continue to ignore the need to ensure postnatal services meet the needs of women who have experienced medically complex pregnancies.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Amanda Bye
- Department of Psychological Medicine, Division of Academic Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Rosanna Hildersley
- Section of Women's Mental Health, Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Olivia Chingara
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Yan-Shing Chang
- Department of Child & Family Health, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, Faculty of Science, Engineering and Medicine, University of Warwick, Coventry, United Kingdom.
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Slater K, Taylor R, McLaughlin K, Pennell C, Collins C, Hutchesson M. Barriers and Facilitators to Cardiovascular Disease Prevention Following Hypertensive Disorders of Pregnancy in Primary Care: Cross-Sectional Surveys. Nutrients 2023; 15:3817. [PMID: 37686849 PMCID: PMC10490358 DOI: 10.3390/nu15173817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Women with a history of hypertensive disorders of pregnancy (HDP) have an increased risk of cardiovascular disease (CVD). Guidelines recommend that women diagnosed with HDP should be advised of their increased CVD risk, have regular blood pressure monitoring by their general practitioner (GP), and adopt healthy lifestyle behaviours. However, within Australia, the current practice in primary health care is unknown. The aim of this study was to describe current practices, barriers, and facilitators to the provision of CVD preventative services for women after HDP in the primary care setting and to identify potential strategies to support GPs in providing recommended care. Separate cross-sectional online surveys were undertaken with 35 GPs and 105 women with a history of HDP. Surveys included both closed- and open-ended questions. Closed-ended questions were analysed using basic descriptive statistics, and open-ended questions were themed and tallied. The survey of GPs revealed that GPs are more likely to assess traditional CVD risk markers than lifestyle risk factors or HDP history. GPs identified a lack of resources and skills as barriers to providing CVD preventative care post-HDP. The survey with women after HDP revealed that women with a history of HDP are more likely to be assessed for blood pressure than lifestyle CVD risk factors, and that the women's barriers to obtaining care included difficulty obtaining an appointment and time required for attending appointments. Strategies to improve CVD preventative care were consistent between surveys, where 70% of GPs and 59% of women chose 'increasing women's awareness of increased CVD risk' and 67% of GPs and 55% of women chose 'improving communication between hospitals and primary care' as their preferred strategies. While the findings suggest that women with a history of HDP are receiving advice consistent with guidelines for traditional CVD risk markers, such as blood pressure, they are less likely to receive CVD preventative care for lifestyle or female-specific CVD risk factors.
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Affiliation(s)
- Kaylee Slater
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rachael Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Karen McLaughlin
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Craig Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Melinda Hutchesson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
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Hussien NA, Shuaib N, Baraia ZA, Laradhi AO, Wang W, Zhang Z. Perceived Cardiovascular Disease Risk Following Preeclampsia: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2356. [PMID: 37628554 PMCID: PMC10454291 DOI: 10.3390/healthcare11162356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Preeclampsia has been linked to an increased risk of cardiovascular disease (CVD), and the preeclamptic women were unaware of this link. Therefore, this study aims to assess women's knowledge and perception of future CVD after preeclampsia. This study used a cross-sectional descriptive design. Two hundred and forty-six women with a preeclampsia history were recruited from the Al Salam MCH Center and Suez Canal University Hospital. Data were collected during March 2022 using a socio-demographic questionnaire, an Adapted Coronary Heart disease knowledge tool for preeclamptic women, and The Perception of Risk of Heart Disease Scale (PRHDS). Most women (96%) were unaware of the relationship between CVD and preeclampsia. The women had a low CVD knowledge level (10.26 ± 6.08) as well as a low perception of cardiovascular disease risk (37.15 ± 7.22). There was a significant positive correlation between CVD knowledge and CVD risk perception (r = 0.434, p = 0.000). This study found that preeclampsia survivors underestimated their CVD risk. Based on these findings, preeclamptic women should receive health education sessions on CVD risk and prevention from their nurses and obstetricians. The hospital pre-discharge plan must contain these sessions in written and electronic formats to help women remember and follow CVD risk reduction measures.
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Affiliation(s)
- Nahed Ahmed Hussien
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
- Faculty of Nursing, Suez Canal University, Ismailia 41522, Egypt;
| | - Nazia Shuaib
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
| | | | - Adel Omar Laradhi
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
| | - Wenna Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
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Hirsch C, Roberts L, Salisbury J, Denney-Wilson E, Henry A, Gow M. The Association between Nutrition, Physical Activity, and Cardiometabolic Health at 6 Months following a Hypertensive Pregnancy: A BP 2 Sub-Study. Nutrients 2023; 15:3294. [PMID: 37571231 PMCID: PMC10421276 DOI: 10.3390/nu15153294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP) complicate 5-10% of pregnancies, with resultant lifelong increased risks of cardiovascular disease (CVD). We aimed to describe lifestyle behaviours at 6 months post-HDP in four HDP subgroups, and their association with markers of cardiometabolic health. Subgroups were chronic hypertension (CH), gestational hypertension (GH), preeclampsia, and preeclampsia superimposed on chronic hypertension (CH + PE). The BP2 study is a multi-site, three-arm, randomised controlled trial. At 6 months postpartum, the NSW Population Health Survey and BP2 surveys collected lifestyle behaviours and demographic data. Body mass index (BMI), waist circumference, and blood pressure (BP) were also assessed. Descriptive statistics, ANOVA and Spearman's correlation coefficients were used. Of 484 women (16% CH, 23% GH, 55% preeclampsia, and 6% CH + PE), 62% were overweight or obese. Only 6% met the recommended five vegetable and two fruit serves per day, and 43% did not meet the recommended 150 min of moderate-vigorous physical activity in five sessions per week. Adherence to both diet and physical activity recommendations was correlated with more favourable cardiometabolic outcomes, including lower BMI, waist circumference, and systolic and diastolic BP. Lifestyle interventions that improve diet and physical activity post-HDP are needed to reduce BP, BMI, and long-term CVD in this high-risk population.
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Affiliation(s)
- Camilla Hirsch
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (C.H.); (A.H.)
| | - Lynne Roberts
- Women’s and Children’s Health, St. George Hospital, Sydney, NSW 2217, Australia;
- St. George and Sutherland Clinical Campus, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing, University of Sydney, Camperdown, Sydney, NSW 2006, Australia;
| | - Amanda Henry
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (C.H.); (A.H.)
- Women’s and Children’s Health, St. George Hospital, Sydney, NSW 2217, Australia;
- St. George and Sutherland Clinical Campus, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Megan Gow
- Women’s and Children’s Health, St. George Hospital, Sydney, NSW 2217, Australia;
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Children’s Hospital Westmead Clinical School, University of Sydney, Sydney, NSW 2006, Australia
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21
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Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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Puglisi CJ, McDonough J, Bianco-Miotto T, A Grieger J. General Practitioners perspectives on infant telomere length screening after a pregnancy complication: a qualitative analysis. Fam Pract 2023:7188177. [PMID: 37262296 DOI: 10.1093/fampra/cmad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Pregnancy complications can impact the mother and child's health in the short and longterm resulting in an increased risk of chronic disease later in life. Telomere length is a biomarker of future cardiometabolic diseases and may offer a novel way of identifying offspring most at risk for future chronic diseases. OBJECTIVE(S) To qualitatively explore General Practitioners' (GPs) perspectives on the feasibility and uptake for recommending a telomere screening test in children who were born after a pregnancy complication. METHODS Twelve semi-structured interviews were conducted with GPs within metropolitan Adelaide, South Australia. Interviews were audio recorded, transcribed verbatim, and analysed for codes and themes. RESULTS Two themes were generated: ethical considerations and practical considerations. Ethically, the GP participants discussed barriers including consenting on behalf of a child, parental guilt, and the impact of health insurance, whereas viewing it for health promotion was a facilitator. For practical considerations, barriers included the difficulty in identifying people eligible for screening, maintaining medical communication between service providers, and time and financial constraints, whereas linking screening for telomere length with existing screening would facilitate uptake. CONCLUSIONS GPs were generally supportive of potential telomere screening in infants, particularly via a saliva test that could be embedded in current antenatal care. However, several challenges, such as lack of knowledge, ethical considerations, and time and financial constraints, need to be overcome before such a test could be implemented into practice.
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Affiliation(s)
- Carolyn J Puglisi
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide 5005, Australia
| | - Joshua McDonough
- School of Public Health, University of Adelaide, Adelaide 5005, Australia
| | - Tina Bianco-Miotto
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide 5005, Australia
- Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
- Adelaide Medical School, University of Adelaide, Adelaide 5005, Australia
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23
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Murray Horwitz ME, Prifti CA, Battaglia TA, Ajayi AT, Edwards CV, Benjamin EJ, Yarrington CD, Parker SE. Prepregnancy Cardiovascular Disease Risk Factors and Adverse Pregnancy Outcomes in a Safety-Net Hospital. J Womens Health (Larchmt) 2023; 32:401-408. [PMID: 36827080 PMCID: PMC10329150 DOI: 10.1089/jwh.2022.0322] [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: 02/25/2023] Open
Abstract
Background: Many adverse pregnancy outcomes (APOs) are associated with elevated cardiovascular disease (CVD) risk. However, APO data in the context of pre-existing CVD risk factors, and from diverse populations, are limited. We assessed the occurrence of APOs among individuals with and without prepregnancy CVD risk factors, overall and by race/ethnicity. Methods: We conducted a retrospective study using electronic medical record data from a large urban safety-net hospital. Individuals with prenatal care and delivery between 2016 and 2018 at the hospital were included, and data from prenatal intake through the delivery hospitalization were captured. The exposure, prepregnancy CVD risk factors (hypertension, diabetes, tobacco use, and obesity), and the outcome, APOs (hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, low birth weight, and stillbirth), were identified from electronic medical records. Results: We identified 3760 unique delivering individuals, of whom 55.1% self-identified as Black non-Hispanic and 17% as Hispanic. Prepregnancy CVD risk factor prevalence was 45.6%, most commonly obesity (26.6%). APO prevalence was 35.6%, most commonly a hypertensive disorder of pregnancy (20.1%). Overall, 45.7% of APOs occurred in the absence of recognized prepregnancy CVD risk factors, representing 16.3% of the total sample. Among individuals without prepregnancy CVD risk factors, APO prevalence was 30.0% and did not vary by race/ethnicity. Conclusions: In this racially and ethnically diverse hospital-based sample, APOs were present in one in three parous individuals without prepregnancy CVD risk factors-a group with potentially elevated CVD risk who might otherwise be missed by traditional CVD risk factor screening.
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Affiliation(s)
- Mara E. Murray Horwitz
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Christine A. Prifti
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tracy A. Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ayodele T. Ajayi
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Camille V. Edwards
- Section of Hematology/Oncology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Christina D. Yarrington
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Samantha E. Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Korb D, Tsatsaris V, Camillieri C, Deneux-Tharaux C. According to patients who an history of preeclampsia, the information they receive in the postpartum period needs to be optimized to initiate appropriate follow up. J Gynecol Obstet Hum Reprod 2023; 52:102582. [PMID: 36948293 DOI: 10.1016/j.jogoh.2023.102582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Diane Korb
- Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Université Paris Cité, APHP, Department of obstetrics and gynaecology, Hôpital Robert Debré.
| | | | | | - Catherine Deneux-Tharaux
- Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
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25
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Haßdenteufel K, Müller M, Gutsfeld R, Goetz M, Bauer A, Wallwiener M, Brucker SY, Joos S, Colombo MG, Hawighorst-Knapstein S, Chaudhuri A, Kirtschig G, Saalmann F, Wallwiener S. Long-term effects of preeclampsia on maternal cardiovascular health and postpartum utilization of primary care: an observational claims data study. Arch Gynecol Obstet 2023; 307:275-284. [PMID: 35482068 PMCID: PMC9836976 DOI: 10.1007/s00404-022-06561-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/01/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Preeclampsia occurs in up to 15% of pregnancies and constitutes a major risk factor for cardiovascular disease. This observational cohort study aimed to examine the association between preeclamptic pregnancies and cardiovascular outcomes as well as primary and specialized care utilization after delivery. METHODS Using statutory claims data we identified women with singleton live births between 2010 and 2017. Main outcomes included the occurrence of either hypertension or cardiovascular disease after one or more preeclamptic pregnancies, number of contacts to a general practitioner or cardiologist after delivery and prescribed antihypertensive medication. Data were analyzed using Cox proportional hazard regression models adjusted for maternal age, diabetes, dyslipidemia, and obesity. RESULTS The study cohort consisted of 181,574 women with 240,698 births. Women who experienced preeclampsia once had an increased risk for cardiovascular (hazard ratio, HR = 1.29) or hypertensive (HR = 4.13) events. In women affected by recurrent preeclampsia, risks were even higher to develop cardiovascular disease (HR = 1.53) or hypertension (HR = 6.01). In the following years after delivery, general practitioners were seen frequently, whereas cardiologists were consulted rarely (0.3 and 2.4%). CONCLUSION Women affected by preeclampsia experience an increased risk of developing chronic hypertension and cardiovascular disease, especially those with recurrent preeclampsia. Future medical guidelines should take this potential risk into account.
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Affiliation(s)
- Kathrin Haßdenteufel
- Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Raphael Gutsfeld
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Maren Goetz
- Department of General Pediatrics, University Children’s Hospital, Heidelberg, Germany
| | - Armin Bauer
- Department of Women’s Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Sara Y. Brucker
- Department of Women’s Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University, Tuebingen, Germany
| | - Miriam Giovanna Colombo
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University, Tuebingen, Germany
| | | | - Ariane Chaudhuri
- Department of Health Promotion, AOK Baden-Wuerttemberg, Stuttgart, Germany
| | - Gudula Kirtschig
- Department of Health Promotion, AOK Baden-Wuerttemberg, Stuttgart, Germany
| | - Frauke Saalmann
- Department of Health Promotion, AOK Baden-Wuerttemberg, Stuttgart, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
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Scholz AS, Hassdenteufel K, Gutsfeld R, Müller M, Goetz M, Bauer A, Wallwiener M, Brucker SY, Joos S, Colombo MG, Hawighorst-Knapstein S, Chaudhuri A, Beck F, Wallwiener S. Observational database study on preeclampsia and postpartum medical care up to 7.5 years after birth. Sci Rep 2022; 12:21230. [PMID: 36482054 PMCID: PMC9732277 DOI: 10.1038/s41598-022-25596-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Preeclampsia is associated with a substantially increased long-term risk for cardiovascular, cerebrovascular and renal disease. It remains unclear whether and to which extent specialized medical postpartum care is sought. We aimed to assess current utilization of postpartum primary and specialized care and medication prescription behavior in women who experienced preeclampsia. This retrospective observational study based on statutory claims data included 193,205 women with 258,344 singleton live births between 2010 and 2017 in Southern Germany. Postpartum care was evaluated by analyzing and comparing the frequency of medical consultations in primary and specialized care and prescriptions for antihypertensive medication among women with and without preeclampsia up to 7.5 years after delivery. Gynecologists and general practitioners were the main health care providers for all women. Although specialized postpartum care was sought by more women after preeclampsia, the effect size indices revealed no considerable association between a history of preeclampsia and the utilization of specialized outpatient aftercare (e.g. 2% vs. 0.6% of patients with and without preeclampsia who consulted a nephrologist during the first year postpartum, r = 0.042). Preeclampsia was associated with an increased risk to take any antihypertensive medication after delivery (HR 2.7 [2.6; 2.8]). Postpartum referral to specialized outpatient care and quarterly prescriptions of antihypertensives following preeclampsia failed to match the early and rapidly increased incidence and risk of hypertension. These data highlight the missed opportunity to implement a reasonable follow-up strategy and prevention management in order to achieve long-term clinical benefits.
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Affiliation(s)
- Anna S Scholz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Kathrin Hassdenteufel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Raphael Gutsfeld
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Maren Goetz
- Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany
| | - Armin Bauer
- Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Sara Y Brucker
- Department of Women's Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Miriam Giovanna Colombo
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Ariane Chaudhuri
- Department of Health Promotion, AOK Baden-Wuerttemberg, Stuttgart, Germany
| | - Frauke Beck
- Department of Health Promotion, AOK Baden-Wuerttemberg, Stuttgart, Germany
| | - Stephanie Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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Louis JM, Parchem J, Vaught A, Tesfalul M, Kendle A, Tsigas E. Preeclampsia: a report and recommendations of the workshop of the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2022.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Dippenaar JM, Moeti TL, Chetty N, StaffordCloete A, Monticelli F. Early identification of hypertensive disorders of pregnancy (An mhealth feasibility study for resource limited settings). INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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29
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Gencheva DG, Nikolov FP, Uchikova EH, Hristova KA, Mihaylov RD, Pencheva BG. Hypertension in pregnancy as an early sex-specific risk factor for cardiovascular diseases: evidence and awareness. Folia Med (Plovdiv) 2022; 64:380-387. [PMID: 35856097 DOI: 10.3897/folmed.64.e64741] [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: 02/21/2021] [Accepted: 03/18/2021] [Indexed: 01/12/2023] Open
Abstract
Despite being a physiological condition, human pregnancy is known to cause numerous complications that can endanger the life of the mother and the fetus alike. While the majority of complications are mostly limited within the peripartum period, more and more information is available about persistently higher short- and long-term cardiovascular risk after a pregnancy complicated by a hypertensive disorder. There is evidence that women after gestational hypertension or preeclampsia are more likely to develop arterial hypertension, coronary atherosclerosis, myocardial infarction, stroke, peripheral artery disease, and even diabetes mellitus and venous thromboembolism years after the target pregnancy. This has urged some authors to view hypertensive disorders of pregnancy as a "stress test" for the maternal organism that unmasks latent endothelial dysfunction. An explanation is sought in the presence of common risk factors and underlying pathological pathways with cardiovascular diseases, although a certain etiological mechanism for the development of hypertensive disorders in pregnancy has not been established yet. More attention is needed towards the follow-up of women after a hypertensive pregnancy as it could be an opportunity for early prevention of cardiovascular diseases.
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Affiliation(s)
| | | | | | | | - Rosen D Mihaylov
- RAMUS Independent Medical Diagnostic Laboratory, Sofia, Bulgaria
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30
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Rossiter C, Henry A, Roberts L, Brown MA, Gow M, Arnott C, Salisbury J, Ruhotas A, Hehir A, Denney-Wilson E. Optimising mothers' health behaviour after hypertensive disorders of pregnancy: a qualitative study of a postnatal intervention. BMC Public Health 2022; 22:1259. [PMID: 35761317 PMCID: PMC9235190 DOI: 10.1186/s12889-022-13590-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Hypertensive disorders of pregnancy have longer-term implications, increasing women’s lifetime cardiovascular disease risk. The Blood Pressure Postpartum study is a multi-centre randomised three-arm trial of interventions, ranging in intensity and including education and lifestyle coaching, to support women to maintain or adopt healthy eating and physical activity during the first postpartum year. This qualitative sub-study nested within the main trial aimed to investigate whether and how women adopted healthy behaviours after a pregnancy complicated by a hypertensive disorder. Methods Semi-structured telephone interviews were recorded, transcribed and analysed thematically, following Braun and Clarke principles. They explored behaviour change among new mothers following their hypertensive pregnancy, and the intervention’s effect on their capacity and motivation to pursue healthy lifestyles. Results Thirty-four women from all three trial arms participated at 10–12 months postpartum. The three main themes were 1) Awareness of cardiovascular risk: some did not acknowledge the health risks, whereas others embraced this information. 2) Sources of motivation: while the majority were motivated to make a concerted effort to adapt their health behaviour, motivation often centred on their baby and family rather than their own needs. 3) Sustaining behaviour change with a new baby: women in the more intensive intervention arm demonstrated increased recognition of the importance of reducing cardiovascular health risks, with greater motivation and guidance to change their health behaviour. There was minimal evidence of crossover amongst groups, with women largely accepting their randomised level of intervention and not seeking additional help when randomised to minimal intervention. Conclusions Among women participating in an early post-hypertensive disorders of pregnancy randomised controlled trial aimed at improving their cardiovascular disease risk profile, the majority recognised the future health risks and appeared motivated to improve their lifestyle, particularly women in the highest-intensity intervention group. This highlights the importance of structured support to assist women embrace healthy lifestyles especially during the challenges of new parenthood. Trial registration The Blood Pressure Postpartum study was prospectively registered as a clinical trial with the Australian New Zealand Clinical Trials Registry (anzctr.org.au) on 13 December 2018 (registration number: ACTRN12618002004246). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13590-2.
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Affiliation(s)
- Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Amanda Henry
- Discipline of Women's Health, Faculty of Medicine and Health, The University of New South Wales, Kensington, NSW, 1466, Australia. .,Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, 2217, Australia.
| | - Lynne Roberts
- Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, 2217, Australia.,St George and Sutherland Clinical School, The University of New South Wales, St George Hospital, Kogarah, NSW, 2217, Australia
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital and the University of NSW, Sydney, Australia
| | - Megan Gow
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, 2145, Australia
| | - Clare Arnott
- The George Institute for Global Health, The University of New South Wales, 1 King Street, Newtown, NSW, 2042, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Justine Salisbury
- NSW Ministry of Health, 1 Reserve Road, St Leonards, NSW, 2065, Australia
| | - Annette Ruhotas
- Consumer and Community Involvement Representative, Sydney, Australia
| | - Angela Hehir
- The George Institute for Global Health, The University of New South Wales, 1 King Street, Newtown, NSW, 2042, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
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Gholami K, Norouzkhani N, Kargar M, Ghasemirad H, Ashtiani AJ, Kiani S, Sajedi Far M, Dianati M, Salimi Y, Khalaji A, Honari S, Deravi N. Impact of Educational Interventions on Knowledge About Hypertensive Disorders of Pregnancy Among Pregnant Women: A Systematic Review. Front Cardiovasc Med 2022; 9:886679. [PMID: 35795374 PMCID: PMC9252511 DOI: 10.3389/fcvm.2022.886679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP), including chronic hypertension, preeclampsia and gestational hypertension, is the cause of about 50,000 deaths out of 400,000 perinatal deaths. HDP is an effective risk factor in stroke, type 2 diabetes, and cardiovascular diseases like ischemic heart disease. There is a significant relation between HDP, lifestyle, and knowledge. Unfortunately, many studies showed that pregnant women have lack of knowledge about HDP. Therefore, the importance of educational interventions is, today, more acknowledged than before. Aim The goal of this systematic review was to investigate the effect of interventional educations on the knowledge of pregnant women about HDP. Methods A systematic review of the related articles was conducted. We included English randomized controlled trials published up to December 2021, including pregnant women as population, HDP as the outcome, and educational interventions as the intervention. Results After the process of study selection, six articles containing 819 pregnant women were included in this study. Educational pamphlets, mobile-based application, a mixture of pamphlets, pictographic magnet and videos, and a combination of PowerPoint and data show projectors and conversation were the educational interventions in these studies. Conclusions The positive effects of educational interventions on the knowledge of women with HTP were observed in all studies. The higher knowledge leads to HDP-related complications. Systematic Review Registration https://archive.org/details/osf-registrations-gcs5r-v1, identifier: doi: 10.17605/OSF.IO/GCS5R.
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Affiliation(s)
- Kosar Gholami
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Meraj Kargar
- Student Research Committee, Afzalipour Faculty of Medicine Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza Ghasemirad
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Shamim Kiani
- Student Research Committee, Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Maryam Dianati
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Yasaman Salimi
- Student Research Committee, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Sara Honari
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Deravi
- Students Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Society for Maternal-Fetal Medicine Special Statement: Quality metric for timely postpartum follow-up after severe hypertension. Am J Obstet Gynecol 2022; 227:B2-B8. [PMID: 35644249 DOI: 10.1016/j.ajog.2022.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality. Because postpartum exacerbation of severe hypertension is common, the American College of Obstetricians and Gynecologists recommends that patients with severe hypertension during the childbirth hospitalization be seen within 72 hours after discharge. In this statement, the Society for Maternal-Fetal Medicine proposes a uniform metric reflecting the rate of timely postpartum follow-up of patients with severe hypertension. The metric is designed to be measured using automated calculations based on billing codes derived from claims data. The metric can be used in quality improvement projects to increase the rate of timely follow-up in patients with severe hypertension during the childbirth hospitalization. Suggested steps for implementing such a project are outlined.
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Roth H, Morcos V, Roberts LM, Hanley L, Homer CSE, Henry A. Preferences of Australian healthcare providers regarding education on long-term health after hypertensive disorders of pregnancy: a qualitative study. BMJ Open 2022; 12:e055674. [PMID: 35618327 PMCID: PMC9137339 DOI: 10.1136/bmjopen-2021-055674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore Australian healthcare providers' (HCPs') preferred content, format and access to education regarding long-term health after hypertensive disorder of pregnancy (HDP), in order to guide the development of education programmes. DESIGN AND SETTING A qualitative study using a framework analysis was undertaken. Registered HCP who were practising in Australia and previously completed a survey about long-term health after HDP were invited to participate. PARTICIPANTS Twenty HCP were interviewed, including midwives, specialist obstetrician/gynaecologists, general practitioners with a diploma in obstetrics and gynaecology, and cardiologists. PRIMARY AND SECONDARY OUTCOME MEASURES Exploration of preferred content, format and distribution of educational material post-HDP. RESULTS Twenty HCP were interviewed in April to May 2020. Four main categories were identified. 'Obtaining evidence-based information for own learning' addressing own learning with preference for multi-disciplinary education, preferably endorsed or facilitated by professional organisations. 'Optimising the referral process from hospital to community health services' was about the need for structured long-term follow-up to transition from hospital to community health and align with HDP guidelines. 'Facilitating women's health literacy' addressed the need for evidence-based, print or web-based material to assist risk discussions with women. 'Seizing educational opportunities' addressed the responsibility of all HCP to identify education opportunities to initiate key health discussions with women. CONCLUSIONS HCP provided ideas on content, format and access of education regarding long-term health post-HDP within the parameters of the Australian healthcare context. This evidence will guide educational developments for HCP on post-HDP health to ensure they can better care for women and families.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Veronica Morcos
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Lynne M Roberts
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Women's and Children's Health, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Lisa Hanley
- Maternity Consumer, Saint George Hospital, Kogarah, New South Wales, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Amanda Henry
- Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Women's Health, The George Institute for Global Health, Newtown, New South Wales, Australia
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Sheehan E, Wang C, Cauldwell M, Bick D, Thilaganathan B. Understanding maternal postnatal blood pressure changes following hypertensive disorders in pregnancy: protocol for a prospective cohort study. BMJ Open 2022; 12:e060087. [PMID: 35365547 PMCID: PMC8977789 DOI: 10.1136/bmjopen-2021-060087] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Hypertensive disorders occur in approximately 10% of women during pregnancy. There is robust population-based data to show that women who have hypertension in pregnancy are much more likely to develop cardiovascular disease (CVD) in the postpartum period. Women with a hypertensive disorder of pregnancy (HDP) are twice more at risk of heart disease and stroke, and four times more likely to develop hypertension after birth. Two out of three women who had HDP will die from CVD. Recent evidence suggests that young women with HDP develop signs of CVD in the immediate postpartum period, rather than several decades later as previously presumed. If confirmed, this concerning finding presents healthcare practitioners with an opportunity to influence women's cardiovascular health by advising on lifestyle choices and considering therapeutic interventions to prevent the development of CVD. METHODS AND ANALYSIS This prospective cohort study design will ask approximately 300 participants to complete 3 days of home blood pressure monitoring every fortnight for 12 weeks postpartum and will culminate with a 24-hour episode of ambulatory blood pressure monitoring at 12 weeks postpartum. Women and healthcare professionals will complete questionnaires surrounding postpartum care for women who had HDP and knowledge of CVD risk. In addition, the relationship between hypertension and factors likely to influence outcomes such as severity of HDP, maternal age, body mass index and ethnicity will be analysed using logistic regression. Blood pressure and data from questionnaires will be analysed using descriptive statistics, with temporal stratification. ETHICS AND DISSEMINATION Research ethics approval was obtained from London-West London & GTAC Research Ethics Committee. Research outputs will be published and disseminated through midwifery, obstetric or general practitioner targeted academic journals. The patient and public involvement group will disseminate findings to women who have experienced HDP among their peer groups. TRIAL REGISTRATION NUMBER NCT05137808.
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Affiliation(s)
- Elaine Sheehan
- Molecular and Clinical Sciences Research Institute, St George's University of London Molecular and Clinical Sciences Research Institute, London, UK
- Maternal Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Chao Wang
- Faculty of Health, Social Care and Education, Kingston University and St. George's, University of London, London, UK
| | - Matthew Cauldwell
- Maternal Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Basky Thilaganathan
- Molecular and Clinical Sciences Research Institute, St George's University of London Molecular and Clinical Sciences Research Institute, London, UK
- Fetal Medicine, St George's University of London Molecular and Clinical Sciences Research Institute, London, UK
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Primary Care-Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review. J Gen Intern Med 2022; 37:912-921. [PMID: 34993867 PMCID: PMC8734553 DOI: 10.1007/s11606-021-07149-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/08/2021] [Indexed: 12/20/2022]
Abstract
Several common adverse pregnancy outcomes can reveal subclinical or latent cardiovascular disease (CVD) risk, transiently exposed through the physiologic stress of pregnancy. The year after pregnancy may be a singular opportunity to identify and initiate treatment for CVD risk, even before the onset of traditional CVD risk factors. However, clinical guidance regarding CVD risk management after adverse pregnancy outcomes is lacking. We therefore conducted a systematic review of US clinical practice guidelines and professional society recommendations to inform primary care-based CVD risk management after adverse pregnancy outcomes. We identified 13 relevant publications. While most recommendations were based on limited or weak evidence, we identified several areas of consensus. First, individuals with an adverse pregnancy outcome associated with future CVD are likely to benefit from CVD risk assessment-accompanied by education, counseling, and support for lifestyle modification-beginning within the first postpartum year. Second, among clinicians, clear and consistent documentation about adverse pregnancy outcomes and recommended follow-up is important to coordinate care after pregnancy. In addition, patients need to be informed about their pregnancy complications and associated CVD risks, so that they can make informed health care and lifestyle decisions. Finally, in general, CVD prevention in the year after an adverse pregnancy outcome focuses on lifestyle modification, reserving pharmacotherapy for the highest-risk patients and those with traditional CVD risk factors. While postpartum lifestyle interventions show promise for reducing CVD risk after adverse pregnancy outcomes, continued research to determine the optimal content, timing, and long-term effects of such interventions is needed.
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Thong EP, Ghelani DP, Manoleehakul P, Yesmin A, Slater K, Taylor R, Collins C, Hutchesson M, Lim SS, Teede HJ, Harrison CL, Moran L, Enticott J. Optimising Cardiometabolic Risk Factors in Pregnancy: A Review of Risk Prediction Models Targeting Gestational Diabetes and Hypertensive Disorders. J Cardiovasc Dev Dis 2022; 9:jcdd9020055. [PMID: 35200708 PMCID: PMC8874392 DOI: 10.3390/jcdd9020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease, especially coronary heart disease and cerebrovascular disease, is a leading cause of mortality and morbidity in women globally. The development of cardiometabolic conditions in pregnancy, such as gestational diabetes mellitus and hypertensive disorders of pregnancy, portend an increased risk of future cardiovascular disease in women. Pregnancy therefore represents a unique opportunity to detect and manage risk factors, prior to the development of cardiovascular sequelae. Risk prediction models for gestational diabetes mellitus and hypertensive disorders of pregnancy can help identify at-risk women in early pregnancy, allowing timely intervention to mitigate both short- and long-term adverse outcomes. In this narrative review, we outline the shared pathophysiological pathways for gestational diabetes mellitus and hypertensive disorders of pregnancy, summarise contemporary risk prediction models and candidate predictors for these conditions, and discuss the utility of these models in clinical application.
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Affiliation(s)
- Eleanor P. Thong
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (E.P.T.); (D.P.G.); (S.S.L.); (H.J.T.); (C.L.H.); (L.M.)
| | - Drishti P. Ghelani
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (E.P.T.); (D.P.G.); (S.S.L.); (H.J.T.); (C.L.H.); (L.M.)
| | - Pamada Manoleehakul
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia; (P.M.); (A.Y.)
| | - Anika Yesmin
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia; (P.M.); (A.Y.)
| | - Kaylee Slater
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.); (M.H.)
| | - Rachael Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.); (M.H.)
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.); (M.H.)
| | - Melinda Hutchesson
- School of Health Sciences, College of Health, Medicine and Wellbeing, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.); (M.H.)
| | - Siew S. Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (E.P.T.); (D.P.G.); (S.S.L.); (H.J.T.); (C.L.H.); (L.M.)
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (E.P.T.); (D.P.G.); (S.S.L.); (H.J.T.); (C.L.H.); (L.M.)
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (E.P.T.); (D.P.G.); (S.S.L.); (H.J.T.); (C.L.H.); (L.M.)
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (E.P.T.); (D.P.G.); (S.S.L.); (H.J.T.); (C.L.H.); (L.M.)
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (E.P.T.); (D.P.G.); (S.S.L.); (H.J.T.); (C.L.H.); (L.M.)
- Correspondence:
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Affiliation(s)
- Lynn M Yee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eliza C Miller
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Senior Editor, JAMA
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McClements L, Richards C, Patel N, Chen H, Sesperez K, Bubb KJ, Karlstaedt A, Aksentijevic D. Impact of reduced uterine perfusion pressure model of preeclampsia on metabolism of placenta, maternal and fetal hearts. Sci Rep 2022; 12:1111. [PMID: 35064159 PMCID: PMC8782944 DOI: 10.1038/s41598-022-05120-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/31/2021] [Indexed: 12/23/2022] Open
Abstract
Preeclampsia is a cardiovascular pregnancy complication characterised by new onset hypertension and organ damage or intrauterine growth restriction. It is one of the leading causes of maternal and fetal mortality in pregnancy globally. Short of pre-term delivery of the fetus and placenta, treatment options are limited. Consequently, preeclampsia leads to increased cardiovascular disease risk in both mothers and offspring later in life. Here we aim to examine the impact of the reduced uterine perfusion pressure (RUPP) rat model of preeclampsia on the maternal cardiovascular system, placental and fetal heart metabolism. The surgical RUPP model was induced in pregnant rats by applying silver clips around the aorta and uterine arteries on gestational day 14, resulting in ~ 40% uterine blood flow reduction. The experiment was terminated on gestational day 19 and metabolomic profile of placentae, maternal and fetal hearts analysed using high-resolution 1H NMR spectroscopy. Impairment of uterine perfusion in RUPP rats caused placental and cardiac hypoxia and a series of metabolic adaptations: altered energetics, carbohydrate, lipid and amino acid metabolism of placentae and maternal hearts. Comparatively, the fetal metabolic phenotype was mildly affected. Nevertheless, long-term effects of these changes in both mothers and the offspring should be investigated further in the future.
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Affiliation(s)
- Lana McClements
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Claire Richards
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Nikayla Patel
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Hao Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Kimberly Sesperez
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Kristen J Bubb
- Biomedical Discovery Institute, Monash University, Melbourne, Australia
| | - Anja Karlstaedt
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA, 127 San Vincente Blvd, 90048
| | - Dunja Aksentijevic
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Fraser A, Markovitz AR, Haug EB, Horn J, Romundstad PR, Dalen H, Rich-Edwards J, Åsvold BO. Ten-Year Cardiovascular Disease Risk Trajectories by Obstetric History: A Longitudinal Study in the Norwegian HUNT Study. J Am Heart Assoc 2022; 11:e021733. [PMID: 35014852 PMCID: PMC9238539 DOI: 10.1161/jaha.121.021733] [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: 11/16/2022]
Abstract
Background Women with a history of obstetric complications are at increased risk of cardiovascular disease, but whether they should be specifically targeted for cardiovascular disease (CVD) risk screening is unknown. Methods and Results We used linked data from the Norwegian HUNT (Trøndelag Health) Study and the Medical Birth Registry of Norway to create a population‐based, prospective cohort of parous women. Using an established CVD risk prediction model (A Norwegian risk model for cardiovascular disease), we predicted 10‐year risk of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and nonfatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and high‐density lipoprotein cholesterol, smoking, antihypertensive use, and family history of myocardial infarction). Predicted 10‐year CVD risk scores in women aged between 40 and 60 years were consistently higher in those with a history of obstetric complications. For example, when aged 40 years, women with a history of preeclampsia had a 0.06 percentage point higher mean risk score than women with all normotensive deliveries, and when aged 60 years this difference was 0.86. However, the differences in the proportion of women crossing established clinical thresholds for counseling and treatment in women with and without a complication were modest. Conclusions Findings do not support targeting parous women with a history of pregnancy complications for CVD screening. However, pregnancy complications identify women who would benefit from primordial and primary prevention efforts such as encouraging and supporting behavioral changes to reduce CVD risk in later life.
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Affiliation(s)
- Abigail Fraser
- Population Health Sciences Bristol Medical School University of Bristol Bristol UK.,Medical Research Council Integrative Epidemiology Unit at the University of Bristol Bristol UK
| | - Amanda R Markovitz
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,Division of Women's Health Brigham and Women's Hospital Boston MA.,Connors Center for Women's Health and Gender BiologyBrigham and Women's Hospital Boston MA.,Mathematica Cambridge MA
| | - Eirin B Haug
- Population Health Sciences Bristol Medical School University of Bristol Bristol UK.,Medical Research Council Integrative Epidemiology Unit at the University of Bristol Bristol UK.,K.G. Jebsen Center for Genetic Epidemiology Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Trondheim Norway
| | - Julie Horn
- HUNT Research Center Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Levanger Norway.,Department of Obstetrics and Gynecology Levanger HospitalNord-Trøndelag Hospital Trust Levanger Norway
| | - Pål Richard Romundstad
- Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Trondheim Norway
| | - Håvard Dalen
- Department of Medicine Levanger HospitalNord-Trøndelag Hospital Trust Levanger Norway.,Department of Circulation and Medical Imaging NTNUNorwegian University of Science and Technology Trondheim Norway.,Cardiac Clinic St Olavs HospitalTrondheim University Hospital Trondheim Norway
| | - Janet Rich-Edwards
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,Division of Women's Health Brigham and Women's Hospital Boston MA.,Connors Center for Women's Health and Gender BiologyBrigham and Women's Hospital Boston MA
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Trondheim Norway.,HUNT Research Center Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Levanger Norway.,Department of Endocrinology Clinic of Medicine St. Olavs HospitalTrondheim University HospitalNorwegian University of Science and TechnologyNorwegian University of Science and Technology Trondheim Norway
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Marill MC. Getting To The Heart Of America's Maternal Mortality Crisis. Health Aff (Millwood) 2021; 40:1824-1829. [PMID: 34871087 DOI: 10.1377/hlthaff.2021.01702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A Missouri cardio-obstetrics program and a national registry target the leading cause of maternal death.
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Affiliation(s)
- Michele Cohen Marill
- This article is part of a series on transforming health systems published with support from The Robert Wood Johnson Foundation. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/. Michele Cohen Marill is a freelance reporter based in Atlanta, Georgia. The patient referred to as Megan requested the use of only her first name to protect her privacy
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41
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Roth H, Henry A, Roberts L, Hanley L, Homer CSE. Exploring education preferences of Australian women regarding long-term health after hypertensive disorders of pregnancy: a qualitative perspective. BMC Womens Health 2021; 21:384. [PMID: 34724948 PMCID: PMC8561910 DOI: 10.1186/s12905-021-01524-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnant women. Long-term health issues for these women include 2-3 times the risk of heart attacks, stroke and diabetes, starting within 10 years after pregnancy, making long-term health after HDP of major public health importance. Recent studies suggest this knowledge is not being transferred sufficiently to women and how best to transmit this information is not known. This study explored women's preferred content, format and access to education regarding long-term health after HDP. METHODS This was a qualitative study and framework analysis was undertaken. Women with a history of HDP who had participated in a survey on long-term health after HDP were invited to participate in this study. During telephone interviews women were asked about preferences and priorities concerning knowledge acquisition around long-term health after HDP. RESULTS Thirteen women were interviewed. They indicated that they wanted more detailed information about long-term and modifiable risk factors. Their preference was to receive risk counselling from their healthcare provider (HCP) early after giving birth along with evidence-based, print or web-based information to take home. All women suggested more structured postnatal follow-up, with automated reminders for key appointments. Automated reminders should detail rationale for follow-up, recommended tests and discussion topics to be addressed at the appointment. CONCLUSION Our findings show that most participants wanted information soon after birth with all women wanting information within 12 months post birth, complemented with detailed take-home evidence. Participants indicated preference for structured follow-up via their HCP with automated alerts about the appointment and recommended tests. This evidence can be used to guide the development of education programs for women on health after HDP which may enhance knowledge, preventive health management and more generally improve women's health trajectories.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Amanda Henry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- Department Women's and Children's Health, St George Hospital, Kogarah, Sydney, NSW, 2217, Australia
| | - Lynne Roberts
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- Department Women's and Children's Health, St George Hospital, Kogarah, Sydney, NSW, 2217, Australia
| | | | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Burnet Institute, Maternal, Child and Adolescent Health, Melbourne, VIC, Australia
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Jowell AR, Sarma AA, Gulati M, Michos ED, Vaught AJ, Natarajan P, Powe CE, Honigberg MC. Interventions to Mitigate Risk of Cardiovascular Disease After Adverse Pregnancy Outcomes: A Review. JAMA Cardiol 2021; 7:346-355. [PMID: 34705020 DOI: 10.1001/jamacardio.2021.4391] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance A growing body of evidence suggests that adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy, gestational diabetes (GD), preterm birth, and intrauterine growth restriction, are associated with increased risk of cardiometabolic disease and cardiovascular disease (CVD) later in life. Adverse pregnancy outcomes may therefore represent an opportunity to intervene to prevent or delay onset of CVD. The objective of this review was to summarize the current evidence for targeted postpartum interventions and strategies to reduce CVD risk in women with a history of APOs. Observations A search of PubMed and Ovid for English-language randomized clinical trials, cohort studies, descriptive studies, and guidelines published from January 1, 2000, to April 30, 2021, was performed. Four broad categories of interventions were identified: transitional clinics, lifestyle interventions, pharmacotherapy, and patient and clinician education. Observational studies suggest that postpartum transitional clinics identify women who are at elevated risk for CVD and may aid in the transition to longitudinal primary care. Lifestyle interventions to increase physical activity and improve diet quality may help reduce the incidence of type 2 diabetes in women with prior GD; less is known about women with other prior APOs. Metformin hydrochloride may prevent development of type 2 diabetes in women with prior GD. Evidence is lacking in regard to specific pharmacotherapies after other APOs. Cardiovascular guidelines endorse using a history of APOs to refine CVD risk assessment and guide statin prescription for primary prevention in women with intermediate calculated 10-year CVD risk. Research suggests a low level of awareness of the link between APOs and CVD among both patients and clinicians. Conclusions and Relevance These findings suggest that transitional clinics, lifestyle intervention, targeted pharmacotherapy, and clinician and patient education represent promising strategies for improving postpartum maternal cardiometabolic health in women with APOs; further research is needed to develop and rigorously evaluate these interventions. Future efforts should focus on strategies to increase maternal postpartum follow-up, improve accessibility to interventions across diverse racial and cultural groups, expand awareness of sex-specific CVD risk factors, and define evidence-based precision prevention strategies for this high-risk population.
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Affiliation(s)
- Amanda R Jowell
- Currently a medical student at Harvard Medical School, Boston, Massachusetts
| | - Amy A Sarma
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Corrigan Women's Heart Health Program, Massachusetts General Hospital, Boston
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur J Vaught
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Surgical Critical Care, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pradeep Natarajan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Camille E Powe
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Michael C Honigberg
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Corrigan Women's Heart Health Program, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Cardiovascular Research Center, Massachusetts General Hospital, Boston
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Andersson ME, Rubertsson C, Hansson SR. The experience of provided information and care during pregnancy and postpartum when diagnosed with preeclampsia: A qualitative study. Eur J Midwifery 2021; 5:37. [PMID: 34568778 PMCID: PMC8424697 DOI: 10.18332/ejm/139488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Despite preeclampsia being one of the most severe obstetrical complications there is only scant research describing women's experiences of preeclampsia. The aim of this study was to explore women's experience during pregnancy and the postpartum period regarding the provided information and care concerning preeclampsia. METHODS A qualitative study was designed. Semi-structured face-to-face interviews were performed with fifteen women who were diagnosed with preeclampsia and included at two maternity units located in southern Sweden. The material was analyzed using content analysis. RESULTS Suffering from preeclampsia was understood as being stressful, illustrated in four themes: fragmented information, lack of care planning, separation postpartum, and overall stress and worry. CONCLUSIONS The women experienced fragmented obstetrical care and information deficits when diagnosed with preeclampsia. Our findings indicate a need for additional support and professional guidance due to increased stress, worry, and despair of being separated from the newborn. Future research investigating specific care-planning and postpartum follow-up are suggested as steps to improve care for women with a pregnancy complicated by preeclampsia.
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Affiliation(s)
- Maria E Andersson
- Obstetrics and Gynecology Unit, Section V, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Skåne University Hospital (SUS), Lund, Sweden
| | - Christine Rubertsson
- Skåne University Hospital (SUS), Lund, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stefan R Hansson
- Obstetrics and Gynecology Unit, Section V, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Skåne University Hospital (SUS), Lund, Sweden
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44
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Murray Horwitz ME, Molina RL, Battaglia TA. Preventing Chronic Diseases After Complicated Pregnancies in the COVID-19 Era: a Call to Action for PCPs. J Gen Intern Med 2021; 36:2127-2129. [PMID: 33782883 PMCID: PMC8006867 DOI: 10.1007/s11606-021-06734-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mara E Murray Horwitz
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 1, Boston, MA, 02118, USA.
| | - Rose L Molina
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 1, Boston, MA, 02118, USA
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45
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An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia. Sci Rep 2021; 11:12596. [PMID: 34131246 PMCID: PMC8206322 DOI: 10.1038/s41598-021-92078-2] [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: 02/06/2021] [Accepted: 06/03/2021] [Indexed: 12/02/2022] Open
Abstract
Women with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions.
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46
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Richards C, Sesperez K, Chhor M, Ghorbanpour S, Rennie C, Ming CLC, Evenhuis C, Nikolic V, Orlic NK, Mikovic Z, Stefanovic M, Cakic Z, McGrath K, Gentile C, Bubb K, McClements L. Characterisation of cardiac health in the reduced uterine perfusion pressure model and a 3D cardiac spheroid model, of preeclampsia. Biol Sex Differ 2021; 12:31. [PMID: 33879252 PMCID: PMC8056582 DOI: 10.1186/s13293-021-00376-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Preeclampsia is a dangerous cardiovascular disorder of pregnancy that leads to an increased risk of future cardiovascular and metabolic disorders. Much of the pathogenesis and mechanisms involved in cardiac health in preeclampsia are unknown. A novel anti-angiogenic protein, FKBPL, is emerging as having a potential role in both preeclampsia and cardiovascular disease (CVD). Therefore, in this study we aimed to characterise cardiac health and FKBPL regulation in the rat reduced uterine perfusion pressure (RUPP) and a 3D cardiac spheroid model of preeclampsia. Methods The RUPP model was induced in pregnant rats and histological analysis performed on the heart, kidney, liver and placenta (n ≥ 6). Picrosirius red staining was performed to quantify collagen I and III deposition in rat hearts, placentae and livers as an indicator of fibrosis. RT-qPCR was used to determine changes in Fkbpl, Icam1, Vcam1, Flt1 and Vegfa mRNA in hearts and/or placentae and ELISA to evaluate cardiac brain natriuretic peptide (BNP45) and FKBPL secretion. Immunofluorescent staining was also conducted to analyse the expression of cardiac FKBPL. Cardiac spheroids were generated using human cardiac fibroblasts and human coronary artery endothelial cells and treated with patient plasma from normotensive controls, early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE); n = 3. FKBPL and CD31 expression was quantified by immunofluorescent labelling. Results The RUPP procedure induced significant increases in blood pressure (p < 0.001), collagen deposition (p < 0.001) and cardiac BNP45 (p < 0.05). It also induced a significant increase in cardiac FKBPL mRNA (p < 0.05) and protein expression (p < 0.01). RUPP placentae also exhibited increased collagen deposition and decreased Flt1 mRNA expression (p < 0.05). RUPP kidneys revealed an increase in average glomerular size (p < 0.05). Cardiac spheroids showed a significant increase in FKBPL expression when treated with LOPE plasma (p < 0.05) and a trend towards increased FKBPL expression following treatment with EOPE plasma (p = 0.06). Conclusions The rat RUPP model induced cardiac, renal and placental features reflective of preeclampsia. FKBPL was increased in the hearts of RUPP rats and cardiac spheroids treated with plasma from women with preeclampsia, perhaps reflective of restricted angiogenesis and inflammation in this disorder. Elucidation of these novel FKBPL mechanisms in cardiac health in preeclampsia could be key in preventing future CVD. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-021-00376-1.
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Affiliation(s)
- Claire Richards
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Kimberly Sesperez
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Michael Chhor
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Sahar Ghorbanpour
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Claire Rennie
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Clara Liu Chung Ming
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
| | - Chris Evenhuis
- The iThree Institute, University of Technology Sydney, Sydney, NSW, Australia
| | - Valentina Nikolic
- Department of Pharmacology and Toxicology & Department of Internal Medicine - Gynaecology, Medical Faculty, University of Nis, Nis, Serbia
| | - Natasa Karadzov Orlic
- Department of Gynaecology and Obstetrics, Narodni Front, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Zeljko Mikovic
- Department of Gynaecology and Obstetrics, Narodni Front, Belgrade, Serbia.,Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Milan Stefanovic
- Department of Pharmacology and Toxicology & Department of Internal Medicine - Gynaecology, Medical Faculty, University of Nis, Nis, Serbia.,Department of Gynaecology and Obstetrics, Clinical Centre Nis, Nis, Serbia
| | - Zoran Cakic
- Department of Gynaecology and Obstetrics, General Hospital of Leskovac, Leskovac, Serbia
| | - Kristine McGrath
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Carmine Gentile
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia.,The Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Kristen Bubb
- The Kolling Institute, University of Sydney, Sydney, NSW, Australia.,Biomedical Discovery Institute, Monash University, Melbourne, Australia
| | - Lana McClements
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia.
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47
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Pittara T, Vyrides A, Lamnisos D, Giannakou K. Pre-eclampsia and long-term health outcomes for mother and infant: an umbrella review. BJOG 2021; 128:1421-1430. [PMID: 33638891 DOI: 10.1111/1471-0528.16683] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/23/2020] [Accepted: 02/09/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pre-eclampsia is a pregnancy-associated condition with complex disease mechanisms and a risk factor for various long-term health outcomes for the mother and infant. OBJECTIVE To summarise evidence on the association of pre-eclampsia with long-term health outcomes arising in women and/or infants. SEARCH STRATEGY PubMed, EMBASE, Scopus and ISI Web of Science were searched from inception to July 2020. SELECTION CRITERIA Systematic reviews and meta-analyses examining associations between pre-eclampsia and long-term health outcomes in women and their infants. DATA COLLECTION AND ANALYSIS Data were extracted by two independent reviewers. We re-estimated the summary effect size by random-effects and fixed-effects models, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, any evidence of small-study effects and excess significance bias. RESULTS Twenty-one articles were included (90 associations). Seventy-nine associations had nominally statistically significant findings (P < 0.05). Sixty-five associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in seven and two associations, respectively. Nine associations: cerebrovascular disease (cohort studies), cerebrovascular disease (overall), cardiac disease (cohort studies), dyslipidaemia (all studies), risk of death (late-onset pre-eclampsia), fatal and non-fatal ischaemic heart disease, cardiovascular mortality (cohort studies), any diabetes or use of diabetic medication (unadjusted), and attention deficit/hyperactivity disorder (ADHD) (adjusted) were supported with robust evidence. CONCLUSION Many of the meta-analyses in this research field have caveats casting doubts on their validity. Current evidence suggests an increased risk for women to develop cardiovascular-related diseases, diabetes and dyslipidaemia after pre-eclampsia, while offspring exposed to pre-eclampsia are at higher risk for ADHD. TWEETABLE ABSTRACT Cardiovascular and cerebrovascular diseases were supported with convincing evidence for long-term health outcomes after pre-eclampsia.
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Affiliation(s)
- T Pittara
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - A Vyrides
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - D Lamnisos
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - K Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
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48
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Barrett PM. Editorial: Adverse Pregnancy Outcomes-A Missed Opportunity to Prevent Chronic Disease? Int J Public Health 2021; 66:582810. [PMID: 34366764 PMCID: PMC8336677 DOI: 10.3389/ijph.2021.582810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter M Barrett
- 1School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland.,Wellcome Trust/HRB Irish Clinical Academic Training (ICAT) Programme, University College Cork, Cork, Ireland
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49
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Roth H, Homer CSE, LeMarquand G, Roberts LM, Hanley LI, Brown M, Henry A. Assessing Australian women's knowledge and knowledge preferences about long-term health after hypertensive disorders of pregnancy: a survey study. BMJ Open 2020; 10:e042920. [PMID: 33334841 PMCID: PMC7747529 DOI: 10.1136/bmjopen-2020-042920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/02/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To (1) assess women's current knowledge regarding long-term cardiovascular health after hypertensive disorders of pregnancy (2) elicit women's preferred educational content and format regarding health after hypertensive disorders of pregnancy. DESIGN AND SETTING A custom-created online survey exploring Australian women's knowledge about long-term health after hypertensive disorders of pregnancy, distributed through consumer groups and social media. PARTICIPANTS 266 women with (n=174) or without (n=92) a history of hypertensive disorders of pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Proportion of women identifying long-term health risks after hypertensive disorder of pregnancy using a 10-point risk knowledge score with 0-4 'low', 4.1-7.0 'moderate' and 7.1-10 'high'. (2) Exploration of preferred content, format and distribution of educational material post hypertensive disorder of pregnancy. RESULTS Knowledge scores about health after hypertensive disorder of pregnancy were moderate in groups with and without a history of the disorder. Knowledge was highest regarding risk of recurrent hypertensive disorders in a subsequent pregnancy, 'moderate' for chronic hypertension and heart attack, 'moderate' and 'low' regarding risk of heart disease and 'low' for diabetes and renal disease. Only 36% of all participants were aware that risks start within 10 years after the affected pregnancy. The majority of respondents with a history of hypertensive disorder of pregnancy (76%) preferred receiving information about long-term health 0-6 months post partum from a healthcare provider (80%), key organisations (60%), social media (47%) and brochures/flyers (43%). CONCLUSIONS Women's knowledge regarding health risks after hypertensive disorder of pregnancy was 'moderate', although with important disease-specific gaps such as increased risk of diabetes. Most women wanted to be informed about their long-term health from a healthcare provider.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Grace LeMarquand
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne M Roberts
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Women's and Children's Health, Saint George Hospital, Sydney, New South Wales, Australia
| | - LIsa Hanley
- Maternity Consumer, Saint George Hospital, Sydney, New South Wales, Australia
| | - Mark Brown
- Renal Medicine, Saint George Hospital, Sydney, New South Wales, Australia
- St George & Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Amanda Henry
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Women's and Children's Health, Saint George Hospital, Sydney, New South Wales, Australia
- The George Institute, Sydney, New South Wales, Australia
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50
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Barrett PM, Khashan AS, McCarthy FP, Kublickiene K. Adverse pregnancy outcomes and maternal health: Action needed for long-term benefit. Acta Obstet Gynecol Scand 2020; 99:1107-1109. [PMID: 32609893 DOI: 10.1111/aogs.13945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Peter M Barrett
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,INFANT Research Center, University College Cork, Cork, Ireland.,Wellcome Trust/HRB Irish Clinical Academic Training (ICAT) Program, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,INFANT Research Center, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Center, University College Cork, Cork, Ireland.,Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Karolina Kublickiene
- Renal Medicine, Department of Clinical Intervention, Science & Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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