American Heart Association Scientific Statement
Summary This statement summarizes the evidence that adverse pregnancy outcomes (APO) such as hypertensive disorders of pregnancy, preterm birth, gestational diabetes, small-for-gestational-age birth, placental abruption, and pregnancy loss increase a woman’s risk of developing cardiovascular disease (CVD). risk factors and developing subsequent CVD (including fatal and non-fatal coronary heart disease, stroke, peripheral vascular disease and heart failure). This statement highlights the importance of recognizing APOs when assessing CVD risk in women, although their value for risk reclassification may not be established. A history of APO is an indicator of more vigorous primary prevention of CVD risk factors and primary prevention of CVD. Adopting a heart-healthy diet and increasing physical activity among women with APO, beginning postpartum and continuing throughout life, are important lifestyle interventions to decrease CVD risk. Breastfeeding and lactation may reduce a woman’s subsequent cardiometabolic risk. Black and Asian women experience a higher proportion of APO, with more severe clinical presentation and worse outcomes than white women. More studies on APO and CVD in non-white women are needed to better understand and address these health disparities. Future studies of aspirin, statins, and metformin may better inform our recommendations for pharmacotherapy in the primary prevention of CVD among women who have had APO. There are several opportunities for healthcare systems to improve transitions of care for women with APO and implement strategies to reduce their long-term CVD risk. One proposed strategy includes incorporating the fourth trimester concept into clinical recommendations and healthcare policy. |
Six pregnancy-related complications (high blood pressure, gestational diabetes, preterm birth, small-for-gestational-age baby, pregnancy loss, or placental abruption) increase a woman’s risk of developing cardiovascular disease (CVD) later in life. life, according to a new scientific statement from the American Heart Association, published today in the Association’s flagship journal, Circulation .
The statement calls for aggressive prevention of these risk factors and primary prevention of CVD for women who experience these complications as they transition from pregnancy and postpartum care to primary care, with ongoing follow-up to manage CVD risk. lifelong.
Approximately 10% to 15% of pregnant women experience adverse pregnancy outcomes, which are maternal or fetal complications, including the six that are closely related to the risk of subsequent CVD, as well as other measures related to the health of the baby, such as low birth weight, large for gestational age, and fetal growth restriction.
"Adverse pregnancy outcomes are associated with women who have hypertension, diabetes, abnormal cholesterol, and cardiovascular disease events, including heart attacks and strokes, long after their pregnancies," said Nisha I. Parikh, MD, MPH, president of the scientific statements writing committee and associate professor of medicine in the cardiovascular division at the University of California, San Francisco.
"Prevention or early treatment of risk factors can prevent cardiovascular disease, therefore, adverse pregnancy outcomes can be a powerful window into cardiovascular disease prevention if women and their health professionals take advantage of the knowledge and use it to improve health.
This comprehensive statement reviews the most recent scientific literature on adverse pregnancy outcomes and cardiovascular disease, specifically focused on health disparities, lifestyle, and prevention recommendations.
"The evidence linking adverse pregnancy outcomes with subsequent cardiovascular disease is consistent over many years and is confirmed in almost all of the studies we examined. This statement should inform future prevention guidelines in terms of the important factors to consider in determining women’s risk of heart disease and stroke," Parikh said.
The statement reports the magnitude of risk related to several pregnancy complications:
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More studies are needed that examine the association of pregnancy complications and cardiovascular risk in black, Hispanic, and Asian women. Women in these racial/ethnic groups experience more adverse pregnancy outcomes and have a greater burden of cardiovascular disease and cardiovascular disease risk factors compared to white women.
The statement writing group suggests that aggressive risk factor modification is especially important to prevent cardiovascular disease in women from these racial/ethnic groups who have had adverse pregnancy outcomes.
A healthy diet improves cardiovascular health in all women, and studies suggest that a healthy eating pattern in the three years before pregnancy is associated with lower risks of complications during pregnancy.
"Adopting a heart-healthy diet, healthy sleep patterns, and increasing physical activity among women who experience adverse pregnancy outcomes should begin during pregnancy and continue postpartum and throughout the rest of the patient’s life. These are important lifestyle interventions to decrease the risk of CVD," Parikh said.
The statement also notes that lactation/breastfeeding may reduce the risk of cardiovascular disease and metabolic disorders in a woman’s later life, including type 2 diabetes.
The writing group also suggests opportunities to improve the transition of care after pregnancy:
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If a woman has had any of these adverse pregnancy outcomes, consider close monitoring of blood pressure, type 2 diabetes and lipid screening , and more aggressive risk factor modification and prevention recommendations. cardiovascular disease," Parikh said. "Our data support the AHA’s previous recommendation that these important adverse pregnancy outcomes should be "risk enhancers" to guide consideration of statin therapy aimed at preventing cardiovascular disease in women".
The statement also suggests considering preventive medications as appropriate for certain patients. However, more research is needed to better understand the impact of medications to prevent cardiovascular disease in women after adverse pregnancy outcomes.
In an accompanying editorial, Eliza C. Miller, MD, MS, assistant professor of neurology at Columbia University, writes that pregnancy and the postpartum period are a critical time window in a woman’s life for identifying disease risk. cardiovascular and improve women’s health trajectory. "Pregnancy and the postpartum period should be considered the ’golden year’ of opportunity for physicians to identify young women at risk and work with them to improve their future cardiovascular health," Ella Miller said.
