Adverse pregnancy outcomes and later cardiovascular disease
Such adverse pregnancy outcomes (APOs) as miscarriage, preterm birth, low-birth weight, gestational diabetes, preeclampsia, and placental abruption have been reported to be associated with an increased risk of later cardiovascular morbidity and mortality. Counseling your patients who have experienced an APO about the protective effect of breastfeeding, eating a heart-healthy diet, exercise, and optimizing weight may help them to live a long and healthy life.
Beyond the fourth trimester
The fourth trimester is the 12-week period following birth. At the comprehensive postpartum visit, the American College of Obstetricians and Gynecologists (ACOG) recommends that women with APOs be counseled about their increased lifetime risk of maternal cardiometabolic disease.21 In addition, ACOG recommends that at this visit the clinician who will assume primary responsibility for the woman’s ongoing medical care in her primary medical home be clarified. One option is to ensure a high-quality hand-off to an internal medicine or family medicine clinician. Another option is for a clinician in the ObGyn’s office practice, including a physician assistant, nurse practitioner, or office-based ObGyn, to assume some role in the primary care of the woman.
An APO is not only a pregnancy problem
An APO reverberates across a woman’s lifetime, increasing the risk of CVD and diabetes. In the United States the mean age at first birth is 27 years.1 The mean life expectancy of US women is 81 years.22 Following a birth complicated by an APO there are 5 decades of opportunity to improve health through lifestyle changes and medication treatment of obesity, hypertension, dyslipidemia, and hyperglycemia, thereby reducing the risk of CVD.
