Postpartum CV counseling rates remain low after adverse pregnancy outcomes
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Key takeaways:
- Approximately 60% of people with prepregnancy CV risk factors received CV health counseling after delivery.
- Equitable interventions are needed to improve CV health counseling.
Data show no meaningful differences or changes in the prevalence of postpartum CV health counseling among people with CVD risk factors from 2016 through 2020, despite increasing awareness of the importance of CV health promotion.
In a serial cross-sectional analysis of nationally representative data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS), researchers found that the prevalence of self-reported postpartum counseling for healthy eating, exercise and losing weight gained during pregnancy was approximately 60% and experienced small declines from 2016 through 2020 among people with prepregnancy CVD risk factors or adverse pregnancy outcomes.
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“Only six out of 10 people with risk factors for heart disease report receiving counseling on their heart health at their routine postpartum visit,” Natalie A. Cameron, MD, internal medicine specialist and instructor at Northwestern University Feinberg School of Medicine, told Healio. “Improving heart health counseling during the postpartum period will require a multipronged approach that is centered around health equity. First, public health and hospital policies must address barriers that drive inequities in timely postpartum care, such as poor access to transportation or childcare. Second, we need to develop standardized protocols to screen for heart disease risk factors and barriers to achieving optimal heart health during the postpartum period. Third, we need to improve care transitions from pregnancy to long-term preventive care during the postpartum period.”
Self-reported counseling rates
Cameron, Sadiya S. Khan, MD, MSc, FACC, FAHA, assistant professor of medicine and preventive medicine, associate program director of the cardiovascular disease fellowship and director of research in the section of heart failure at Northwestern University Feinberg School of Medicine, and colleagues analyzed survey data from 167,705 PRAMS participants, conducted at 2 to 6 months after a live birth via either telephone or mail. The primary analysis included people who attended a postpartum visit 4 to 6 weeks after delivery with available data on the receipt of CV health counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes and hypertension) and adverse pregnancy outcomes, defined as gestational diabetes, hypertensive disorders of pregnancy and preterm birth.
Researchers calculated the prevalence of self-reported CV health counseling annually from 2016 through 2020, age-standardized to the 2016 population per 100 individuals, overall and by the total number of CVD risk factors (0, 1 or 2 prepregnancy risk factors and adverse pregnancy outcomes) present. Researchers also determined the annual prevalence of CV health counseling by each prepregnancy risk factor and adverse pregnancy outcome.
The findings were published in JAMA.
Within the cohort, 77.2% were aged 20 to 34 years, 67.4% had more than a high school education and 26.7% were enrolled in Medicaid at 2 to 6 months postpartum. Most patients were Hispanic (16.1%), non-Hispanic Black (14.2%) or non-Hispanic White (60.2%). From 2016 through 2020, researchers noted an increase in prepregnancy obesity (from 23.3% to 27.5%), gestational diabetes (from 8% to 10.1%) and hypertensive disorders of pregnancy (from 9.7% to 12.3%).
From 2016 through 2020, the prevalence of self-reported postpartum CV health counseling declined from 56.2 per 100 people to 52.8 per 100 people among those with no CVD risk factors (annual percent change, 1.4%; 95% CI, 1.8% to 1%), from 58.5 per 100 people to 57.3 per 100 people among those with one CV risk factor (annual percent change, 0.7%; 95% CI, 1.3% to 0.1) and from 61.9 per 100 people to 59.8 per 100 people among those with two or more risk factors (annual percent change, 0.8%; 95% CI, 1.3% to 0.3).
Counseling rates and risk factors
“Prevalence of self-reported CV health counseling in 2020 was lowest among individuals with hypertensive disorders of pregnancy (55%), which is an adverse pregnancy outcome that is a recognized risk-enhancing factor for CVD and associated with a twofold higher lifetime risk of heart failure and ischemic heart disease,” the researchers wrote.
Compared with people who had no CV risk factors, reporting receipt of counseling was modestly higher among people with one risk factor (RR = 1.05; 95% CI, 1.04- 1.07) and with two or more risk factors (RR = 1.11; 95% CI, 1.09 -1.13).
“The 6-week postpartum visit represents an important opportunity to discuss heart health; however, it is only the start,” Cameron told Healio. “It is essential that individuals identify a source of long-term preventive care either with an obstetrician/gynecologist, primary care clinician or cardiologist to help optimize their heart health throughout their life course.”
For more information:
Natalie A. Cameron, MD, can be reached at natalie.cameron@northwestern.edu.
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