At-Risk Women May Not Receive Cardiovascular Health Counseling at Postpartum Visit

Sadiya S. Khan, MD

Credit: Northwestern University

Approximately 60% of women with risk factors for prepregnancy cardiovascular disease (CVD) reported receiving postpartum counseling on optimizing cardiovascular health, declining slightly from 2016 to 2020, according to new research.¹

The analysis’ findings suggest these at-risk individuals may not be receiving the recommended health counseling on healthy eating, exercise, and losing weight gained during pregnancy at their 6-week postpartum visit, despite being recognized as a critical time to prioritize heart health.

“We need to find ways to take advantage of this prime opportunity when we have a captive audience of people who are already in the doctor’s office, talking about their health at a critical juncture in life,” said corresponding author Sadiya Khan, MD, MSc, an assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine.² “It is hard to create new opportunities. The fourth-trimester visit is an already-ready moment to prioritize maternal heart health.”

Evidence has shown the risk of cardiovascular disease (CVD) morbidity and mortality during the peripartum period is increased among adults who have poor prepregnancy cardiovascular health, as well those who experience adverse pregnancy outcomes (APOs). Although the incidence of poor cardiovascular health has declined in recent decades in the United States, the incidence of APOs, such as hypertensive disorders of pregnant and gestational diabetes, has concurrently increased.

A postpartum visit could serve as an ideal opportunity to counsel for cardiovascular health and improve CVD-related outcomes in subsequent pregnancies and throughout the life course. An analysis of data from 2016-2017 revealed only 40% of individuals in the US who attended a 4- to 6-week postpartum visit reported receiving CVD prevention messages. The current cross-sectional analysis aimed to determine the prevalence, predictors, and trends in self-reported cardiovascular health counseling at the 4- to 6-week postpartum visit.

Investigators collected data from the nationally representative, population-based Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System (PRAMs) survey. Individuals who attended a 4- to 6-week postpartum visit after delivery with available data on receipt of cardiovascular health counseling, prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) were included in the study.

For the purpose of analysis, investigators calculated the annual, age-adjusted prevalence of self-reported postpartum cardiovascular health counseling for health eating, exercise, and losing weight gained during pregnancy per 100 individuals overall and by number of CVD risk factors. An average annual percent change (APC) assessed trends in cardiovascular health counseling in the 5-year period. Pooled data were used to calculate rate ratios (RRs) for counseling, comparing individuals with and without CVD risk factors, after adjustment for age, education, postpartum insurance, and delivery year.

Of 206,080 individuals in PRAMS with a live birth in the US from 2016 - 2020, the weighted percent of individuals who attended a postpartum visit was 88.2% (95% CI, 88.0% to 88.5%). Of this population, the final analysis included 167,705 individuals after exclusions.

Over the study period, the prevalence of self-reported cardiovascular health counseling at the 4- to 6-week postpartum visit decreased from 56.2% (95% CI, 55.0% - 57.4%) to 52.8% (95% CI, 51.7% to 54.0%) among those with no CVD risk factors (APC, –1.4%; 95% CI, –1.8% to –1.0%).

The prevalence of cardiovascular health counseling also decreased from 58.5% to 57.3% (APC, –0.7%; 95% CI, –1.3% to –0.1%) among those with 1 risk factor and from 61.9% to 59.8% (APC, –0.8%; 95% CI, –1.3% to –0.3%) among those with ≥2 risk factors.

Investigators noted individuals with prepregnancy CVD risk factors of APOs were modestly more likely to report postpartum cardiovascular health counseling than those without risk factors. After pooling the 5-year data, the adjusted RR was 1.05 (95% CI, 1.04 - 1.07) times higher among individuals with 1 risk factor and 1.11 (95% CI, 1.09 - 1.13) times higher among those with ≥2 risk factors, compared with those without risk factors.

Lead study author Natalie Cameron, MD, MPH, an instructor of general internal medicine at Northwestern University Feinberg School of Medicine, noted a postpartum visit is an opportunity to reach a significant number of women, but it is only the start of the care process.

“Health care systems must improve continuity of care after pregnancy and help women find clinicians who can provide preventive care,” Cameron said.² “These can be obstetricians/gynecologists, primary care clinicians, or cardiologists, depending on the patient’s needs and the clinician’s expertise.”

References

1. Cameron NA, Yee LM, Dolan BM, O’Brien MJ, Greenland P, Khan SS. Trends in Cardiovascular Health Counseling Among Postpartum Individuals. JAMA. 2023;330(4):359–367. doi:10.1001/jama.2023.11210
2. Northwesternu. Only 60% of at-risk women report getting counseled on Heart Health at their postpartum visit. EurekAlert! July 25, 2023. Accessed July 25, 2023. https://www.eurekalert.org/news-releases/996394.