Q&A: Closing a ‘clear gap’ in postpartum care to reduce heart disease

Key takeaways:

• Many pregnancy-related conditions increase a women’s lifetime risk for CVD.
• The postpartum period is a window for early intervention, follow-up care and risk factor management to prevent CVD.

Women who experience adverse pregnancy outcomes such as preeclampsia or gestational diabetes are at high risk for CVD, yet many of these women are not properly assessed and followed during the critical postpartum period.

The postpartum and interpregnancy periods are key windows of opportunity to assess a women’s CV risk and develop a comprehensive plan to improve their health across the life course. Despite the known risks, evidence-based approaches to managing these patients were lacking, according to Rachel M. Bond, MD, FACC, systems director of women’s heart health at Dignity Health in Arizona and a volunteer member of the American Heart Association’s (AHA) Postpartum System of Care Writing Group. In a scientific statement published in 2024, the AHA writing group outlined a pragmatic approach to postpartum management that includes preventive strategies for optimizing cardiovascular health, using the AHA’s Life’s Essential 8 framework. The statement also highlighted the need for postpartum CVD risk factor screening after any adverse pregnancy outcome.

Healio spoke with Bond about the risks that come with adverse pregnancy outcomes, how the scientific statement came together and the importance of multidisciplinary, team-based care, including a seamless transition to primary care after delivery.

Healio: Why is the postpartum period a key time to assess women’s CV health?

Bond: The postpartum period is a critical window for assessing and addressing women’s cardiovascular health because it is a time when both immediate and long-term risks for heart disease become evident. Many pregnancy-related conditions — such as hypertensive disorders of pregnancy (preeclampsia, gestational hypertension), gestational diabetes and peripartum cardiomyopathy — increase a woman’s lifetime risk for CVD.

Additionally, this period allows for early intervention, ensuring that women receive necessary follow-up care, lifestyle counseling and risk factor management to prevent future cardiac events. Unfortunately, many women do not receive adequate postpartum follow-up, increasing the risk of missed diagnoses and future complications.

Healio: Why was there a need for postpartum systems of care recommendations. How did this come together?

Bond: There was a clear gap in postpartum care, as many women with pregnancy-related cardiac risk factors were not being properly followed up after delivery. Traditional postpartum care often focuses on reproductive health, while cardiovascular risk assessment and long-term prevention strategies are overlooked.

The need for structured postpartum systems of care became evident to ensure a seamless transition from obstetric to cardiovascular care, especially for women at high risk. These recommendations came together through multidisciplinary collaboration among cardiologists, maternal-fetal medicine specialists, nurses, certified nurse midwives, doulas and public health experts to establish an integrated, patient-centered model that prioritizes cardiovascular health during the postpartum period.

Healio: What are the top takeaway points from the recommendations? How can a team model incorporating primary care close these gaps?

Bond: The most important takeaway is multidisciplinary team-based care. This is a structured team model integrating cardiologists, OB/GYNs, maternal-fetal medicine specialists and primary care providers, which is essential to prevent gaps in postpartum care.

There also needs to be a seamless transition to primary care. Many women with pregnancy-related cardiovascular risks are lost to follow-up after delivery. Incorporating primary care physicians and clinicians into the postpartum care team ensures continuous monitoring and long-term cardiovascular risk management.

Women should undergo individualized cardiovascular risk stratification postpartum to identify those at highest risk for long-term heart disease. Addressing modifiable risk factors, such as blood pressure, weight, glucose levels, cholesterol and stress management, during the first postpartum year is key to reducing long-term cardiovascular risk. Any model should also include improved access to specialty care. Establishing structured referral pathways from OB/GYNs to cardiologists ensures that high-risk women receive timely evaluations and interventions.

Healio: How can health care professionals take the four larger themes of this scientific statement — Communication & Education; Holistic, Person-Centered Care; Policy & Advocacy; and System Risk Identification & Stratification — and put them into practice?

Bond: For communication and education:

• Educate patients about their pregnancy-related cardiovascular risks and the importance of postpartum follow-up.
• Improve provider-to-provider communication (eg, between OB/GYNs, primary care doctors and cardiologists) to ensure continuity of care.
• Implement standardized discharge planning protocols that include cardiovascular risk assessments.

Holistic, person-centered care:

• Offer individualized postpartum cardiovascular risk counseling tailored to a woman’s pregnancy history.
• Address social determinants of health (access to care, financial barriers, transportation issues) that may impact follow-up.
• Incorporate mental health support into postpartum cardiovascular care, as stress and postpartum depression are linked to heart disease.

Policy and advocacy:

• Advocate for extended postpartum Medicaid coverage to ensure that all women have access to cardiovascular follow-up beyond the traditional 6-week visit.
• Promote policies that require integrated electronic health records to facilitate seamless referrals between OB/GYNs, cardiologists and primary care providers.
• Support legislation that increases funding for maternal health research and cardiovascular disease prevention in postpartum women.

System risk identification and stratification:

• Implement standardized cardiovascular risk screening protocols for all postpartum women at hospital discharge and during follow-up visits.
• Develop risk-based referral pathways ensuring that high-risk women (eg, those with preeclampsia, gestational hypertension or gestational diabetes) receive timely cardiology follow-up.
• Use remote monitoring tools (blood pressure monitoring, mobile health apps) to track postpartum cardiovascular health in real time.

Healio: What further research is needed to help improve maternal health disparities?

Bond: Despite growing awareness, maternal health disparities remain a critical issue, particularly for Black, Indigenous and low-income women, who experience higher rates of pregnancy-related cardiovascular complications and worse postpartum outcomes. Future research should focus on:

• investigating how genetics, inflammation and hormonal changes contribute to increased postpartum cardiovascular risk in certain populations;
• examining how racism, bias and health care access disparities affect postpartum cardiovascular outcomes;
• comparing the effectiveness of team-based care models that integrate cardiology, OB/GYN and primary care;
• assessing how digital health interventions, such as remote blood pressure monitoring with virtual follow-ups, impact postpartum cardiovascular outcomes;
• conducting longitudinal studies to track cardiovascular disease progression in women with a history of pregnancy complications;
• investigating the impact of early postpartum interventions like lifestyle, medication and stress reduction on long-term heart disease prevention;
• evaluating whether extended postpartum Medicaid coverage improves cardiovascular outcomes; and
• studying the impact of workplace policies such as paid maternity leave and access to care on postpartum health and recovery.

By addressing these research gaps, we can develop evidence-based strategies to reduce maternal health disparities, improve cardiovascular outcomes and ensure that postpartum care prioritizes long-term heart health.

References:

• Lewey J, et al. Circulation. 2024;doi:10.1161/CIR.0000000000001212.
• New postpartum care recommendations target CVD risk. https://newsroom.heart.org/news/new-postpartum-care-recommendations-target-cvd-risk. Published May 16, 2024. Accessed Feb. 3, 2025.

For more information:

Rachel M. Bond, MD, FACC, can be reached at rachel.bond@commonspirit.org; X (Twitter): @DrRachelMBond.