Reducing Postpartum CVD Risk: Key Points

Lewey J, Beckie TM, Brown HL, et al., on behalf of the American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; and Council on Cardiovascular and Stroke Nursing.
Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024;149:e330-e346.

The following are key points to remember from an American Heart Association Scientific Statement on opportunities in the postpartum period to reduce cardiovascular disease (CVD) risk after adverse pregnancy outcomes:

  1. Available evidence shows that adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of CVD. Individuals with adverse pregnancy outcomes also have an increased incidence of CVD risk factors after delivery.
  2. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce CVD risk are lacking.
  3. Life's Essential 8 framework of clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and CVD.
  4. Improvements in postpartum maternal CV health may help reduce risk of future adverse pregnancy outcomes, which may additionally attenuate maternal and offspring CV risk.
  5. Although US-based studies are needed to confirm the optimal blood pressure (BP) threshold in postpartum individuals, it may be reasonable to consider postpartum BP goals based on those established for nonpregnant, age-matched individuals. Ideal BP is <120/80 mm Hg with a BP goal of <130/80 mm Hg for patients with treated chronic hypertension.
  6. Women with gestational diabetes should be screened for dysglycemia at 4-12 weeks’ postpartum with a 2-hour 75-g oral glucose tolerance test, as recommended by the American Diabetes Association. Glucose screening with hemoglobin A1c or fasting glucose should be considered within the first year postpartum for those who do not complete an oral glucose tolerance test.
  7. Given low rates of lipid screening among women of reproductive age, checking a lipid panel within the first year postpartum to establish a baseline is reasonable to screen for familial hypercholesterolemia and for assessment of atherosclerotic CVD risk.
  8. The US Department of Health and Human Services recommends 150 minutes of moderate-intensity exercise per week in the postpartum period. Exercise routines may be resumed or started postpartum gradually and after discussion with the obstetrician-gynecologist. Brisk walking with a baby in a carrier or stroller can help postpartum individuals achieve exercise goals and improve CV health, especially if time and childcare help are limited.
  9. There are several validated screening scales for early recognition of postpartum depression, and early recognition in the postpartum period can lead to appropriate therapeutic interventions to improve maternal outcomes.
  10. Future trials are needed to improve screening of subclinical CVD in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve CV health across the life course.

Clinical Topics: Prevention

Keywords: Heart Disease Risk Factors, Postpartum Period, Pregnancy Complications

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