Scientifc Statement from the AHA on adverse pregnancy outcomes and CVD
Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association
The American Heart Association has published a Scientific Statement on adverse pregnancy outcomes (APOs) and CVD risk. APOs, such as hypertensive disorders of pregnancy, preterm delivery, small-for-gestational-age delivery, gestational diabetes, pregnancy loss, and placental abruption are associated with later CVD risk factors and with clinical CVD in later life. The statement reviews epidemiological evidence linking individual APOs with CVD risk. It also gives recommendations for future research and changes in current health care systems to improve long-term risk reduction for women with APOs.
Healthy dietary patterns and physical activity are important to optimize CV health. In addition, lactation and breastfeeding may reduce long-term CV risk and protect against breast and ovarian cancers. The authors of the statement argue that improved patient education is necessary to inform women with APOs of their increased CVD risk. A longer coverage for postpartum care, instead of a single post-partum visit, would provide an opportunity to improve CVD risk prevention counseling or to screen for the development of CV risk factors. Primary care physicians should also be targeted for education to increase knowledge on the impact of APO’s on CVD risk. A more seamless transfer of information from obstetrics providers to primary care physicians is important to deliver appropriate referrals and counseling. Future studies on the timing and specific lifestyle modifications could lead to evidence-based lifestyle recommendations for women in their childbearing years. Studies towards female-specific risk prediction models are also urgently needed. Studies focused on preventive CVD treatments (such as treatment with aspirin, statins, or metformin) could improve recommendations for pharmacotherapy for women who have had an APO. In addition, studies in diverse populations are needed to investigate whether race and ethnicity modify the association between APOs and CVD.