Barriers and facilitators of cardiovascular disease prevention services for women with prior gestational diabetes or hypertensive disorders of pregnancy: a scoping review

Abstract

Aims: Although CVD screening and preventive care in the early postpartum are recommended for women with prior gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP), certain barriers limit access to such services. We conducted a scoping review to summarize evidence on the barriers and facilitators of CVD prevention services among women with prior GDM or HDP.

Methods: A comprehensive search strategy was used to search articles published in three databases (Ovid Medline, CINAHL, Embase). Studies published in English or French that investigated and reported barriers or facilitators to postpartum CVD screening and preventive care among women with previous GDM and HDP were included. Out of 18,565 studies we screened, 29 studies (12 qualitative, 17 quantitative) were included.

Results: Main individual level barriers including lack of knowledge, health and emotional factors were identified. Competing priorities, lack of family/friend support and mistrust of healthcare providers were the most reported interpersonal level barriers, while gaps in communication was the most significant organizational barrier, and gaps in insurance coverage was the most reported system barrier. Individual level facilitators included a personal desire for better health and availability of postpartum programs, and the most reported interpersonal facilitator was women's commitment to modelling a healthy lifestyle for their children. Organizational level facilitators were access to primary care providers and follow-up visit reminders, and program availability in native languages.

Conclusion: Women with prior GDM or HDP face significant barriers to accessing postpartum CVD prevention services. These barriers ranged from individual-level knowledge gaps to system-level healthcare disparities.

Keywords: Barriers; CVD prevention; Facilitators; Gestational diabetes; Hypertensive disorders of pregnancy; Postpartum.