Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association

Abstract

Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.

Keywords: AHA Scientific Statements; cardiovascular diseases; diabetes, gestational; postpartum period; pregnancy; pregnancy complications; primary prevention.

Figure 1.. Opportunities to improve CVH in the postpartum period after adverse pregnancy outcomes.

Improvements in postpartum maternal cardiovascular health (CVH) may help reduce risk of future adverse pregnancy outcomes (bidirectional arrow), which may additionally attenuate maternal and offspring cardiovascular risk. Modified with permission from Lloyd-Jones et al. © 2022 American Heart Association, Inc.

Figure 2.. Opportunities to identify and treat chronic hypertension in postpartum individuals.

BP indicates blood pressure; CV, cardiovascular; and HTN, hypertension.

Figure 3.. Interventions to reduce CVD risk according to an ecological framework.

National policies to reduce maternal cardiovascular disease (CVD) risk include Medicaid expansion to ensure access to preventive care and contraception. AHA indicates American Heart Association; BP, blood pressure; DPP, Diabetes Prevention Program; HTN, hypertension; and WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.

Figure 4.. Strategies and timeline to reduce cardiovascular risk after APOs.

APO indicates adverse pregnancy outcome; ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; BP, blood pressure; CAC, coronary artery calcium; CV, cardiovascular; CVD, cardiovascular disease; FH, family history; GDM, gestational diabetes; HBPM, home blood pressure monitoring; HDP, hypertensive disorders of pregnancy; HTN, hypertension; LDL-C, low-density lipoprotein cholesterol; OB, obstetrician; and T2D, type 2 diabetes.