Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association

This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman's risk of developing cardiovascular disease...

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Vydáno v:Circulation (New York, N.Y.) Ročník 143; číslo 18; s. e902
Hlavní autoři: Parikh, Nisha I, Gonzalez, Juan M, Anderson, Cheryl A M, Judd, Suzanne E, Rexrode, Kathryn M, Hlatky, Mark A, Gunderson, Erica P, Stuart, Jennifer J, Vaidya, Dhananjay
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 04.05.2021
Témata:
American Heart Association - organization & administration
Cardiovascular Diseases - prevention & control
Female
Humans
Pregnancy
Pregnancy Outcome - epidemiology
Risk Factors
United States
United States
primary prevention
risk factors
pregnancy complications
cardiovascular diseases
pregnancy
AHA Scientific Statements
ISSN:1524-4539, 1524-4539
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Shrnutí:This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman's risk of developing cardiovascular disease (CVD) risk factors and of developing subsequent CVD (including fatal and nonfatal coronary heart disease, stroke, peripheral vascular disease, and heart failure). This statement highlights the importance of recognizing APOs when CVD risk is evaluated in women, although their value in reclassifying risk may not be established. A history of APOs is a prompt for more vigorous primordial prevention of CVD risk factors and primary prevention of CVD. Adopting a heart-healthy diet and increasing physical activity among women with APOs, starting in the postpartum setting and continuing across the life span, are important lifestyle interventions to decrease CVD risk. Lactation and breastfeeding may lower a woman's later cardiometabolic risk. Black and Asian women experience a higher proportion APOs, with more severe clinical presentation and worse outcomes, than White women. More studies on APOs 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 primary CVD prevention among women who have had an APO. Several opportunities exist for health care systems to improve transitions of care for women with APOs and to implement strategies to reduce their long-term CVD risk. One proposed strategy includes incorporation of the concept of a fourth trimester into clinical recommendations and health care policy.
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ISSN:1524-4539
1524-4539
DOI:10.1161/CIR.0000000000000961