Pregnant women, please note! There are six kinds of accidents that should prevent cardiovascular disease | American Heart Association

On March 29, the American Heart Association (AHA) issued a scientific statement stating that six adverse pregnancy outcomes indicate a higher cardiovascular risk, including gestational hypertension, premature birth, gestational diabetes, small for gestational age, placental abruption, miscarriage or stillbirth.

Therefore, when assessing a woman's cardiovascular risk, it is important to ask her if she has a history of adverse pregnancy outcomes. If she has any history of adverse pregnancy outcomes, initial prevention of cardiovascular risk factors and primary prevention of cardiovascular disease should be strengthened in a timely manner.

The AHA expert group reviewed the latest relevant literature and found that:

1. Women who have experienced gestational hypertension (blood pressure > 140/90 mmHg after 20 weeks of pregnancy) have a 67% increased risk of cardiovascular disease in the future, including an 83% increased risk of stroke. Patients with moderate to severe preeclampsia have more than doubled their risk of cardiovascular disease in the future.

2. Women who have had gestational diabetes have a 68% increased risk of developing cardiovascular disease in the future and a 10-fold increased risk of type 2 diabetes.

3. Premature birth (birth before 37 weeks) doubles the risk of developing cardiovascular disease in the future. Premature birth is strongly associated with heart disease, stroke, and cardiovascular disease.

4. Women with placental abruption have an 82% increased risk of developing cardiovascular disease in the future.

5. The risk of developing cardiovascular disease in the future for those who have stillbirths is approximately doubled.

For women with a history of adverse pregnancy outcomes, 3 strategies can be used to reduce their long-term cardiovascular risk.

The first strategy is to extend postpartum follow-up, sometimes referred to as the “fourth trimester.”

Cardiovascular disease risk factors should be assessed at 6 weeks, 8 to 12 weeks, 6 months, and 12 months after delivery, such as measuring blood pressure, calculating body mass index, and providing lifestyle counseling, rather than just a traditional postpartum follow-up.

The second strategy is to improve the handoff of health information between obstetricians and gynecologists and primary care physicians to eliminate inconsistencies in the electronic medical record and improve patient care.

Obstetricians and gynecologists are responsible for care for the first 6 weeks after delivery, and the transition from obstetricians and gynecologists to primary care physicians occurs 8 to 12 weeks after delivery.

A third strategy is to conduct a brief but purposeful history in all women to determine whether they have a history of adverse pregnancy outcomes.

The AHA recommends that women with any history of adverse pregnancy outcomes continue to eat a heart-healthy diet and exercise after delivery.

Women of childbearing age and pregnant women should also adhere to a healthy eating pattern, including eating more fruits, vegetables, beans, nuts and fish, and less red meat and processed meat.

Studies have shown that maintaining a healthy diet in the three years before pregnancy can reduce the risk of adverse pregnancy outcomes.

Additionally, lactation and breastfeeding may reduce a woman's future risk of cardiometabolic disease.

The statement pointed out that future studies are needed to evaluate the role of aspirin, statins, and metformin in the primary prevention of cardiovascular disease in women with adverse pregnancy outcomes.

The scientific statement also pointed out that compared with white women, black, Asian, and Hispanic women have a higher rate of adverse pregnancy outcomes, often more severe clinical symptoms, and a worse prognosis.

A related commentary published on the AHA official website pointed out that pregnancy and postpartum period are the "golden years" in a woman's life. This period provides clinicians with a rare opportunity to identify young women at high cardiovascular risk and help improve their cardiovascular health trajectory.

Some experts also pointed out that "pregnancy is a cardiac stress test!" Premature birth, gestational hypertension, gestational diabetes, and small-for-gestational-age babies will all affect a woman's cardiovascular outcomes throughout her life.

source:

[1]Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association. Circulation. 29 Mar 2021

[2]Pregnancy is the “Golden Year” for Cardiovascular Disease Prevention in Women. American Heart Association. 29 Mar 2021

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