A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population

Aldridge, Emily; Verburg, Petra E.; Sierp, Susan; Dekker, Gustaaf A.; Roberts, Claire T.; Arstall, Margaret

doi:10.3389/fcvm.2019.00184

Cited by 5 publications

(10 citation statements)

References 38 publications

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“…This was an observational study of women attending the postpartum lifestyle intervention clinic from 7th August 2018 to 30th June 2021 at the Lyell McEwin Hospital, located within the Northern Adelaide Local Health Network (NALHN), South Australia ( 19 ). The Central Adelaide Local Health Network Human Research Ethics Committee approved the study [HREC/16/TQEH/258].…”

Section: Methodsmentioning

confidence: 99%

“…The postpartum intervention is a hospital-based outpatient clinical service with an associated quality assurance registry, the methods of both have been previously described ( 19 ). Briefly, eligible patients are offered appointments at approximately 6 and 18 months postpartum to undergo a thorough health assessment and receive individualized health counseling from an expert nurse practitioner.…”

Section: Methodsmentioning

confidence: 99%

“…However, these research-based interventions are often opt-in research studies rather than routine outpatient care, tend to focus on specific complications of pregnancy, such as preeclampsia (15)(16)(17)(18), and the effectiveness of these interventions at reducing cardiovascular and metabolic disease risk has not been rigorously assessed in a real-world clinic setting. The first nurse-led postpartum clinic in Australia was introduced in 2018 at the Lyell McEwin Hospital and aims to provide structured lifestyle and risk education (19). To our knowledge, this is the only published and freely available nurse-led model of care in Australia of standardized, routine, ongoing outpatient care for all eligible women who have experienced a serious complication of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis

Aldridge

Pathirana

Wittwer

et al. 2022

Front. Cardiovasc. Med.

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IntroductionCertain complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, spontaneous preterm birth, and placental abruption, are established independent risk factors for premature cardiovascular disease in women. Metabolic syndrome, which is associated with an increased risk of cardiovascular disease, may be a suitable alternative to traditional cardiovascular risk calculators that underestimate risk in young women. This study aimed to investigate the prevalence of metabolic syndrome in women who experienced a complicated pregnancy 6 months earlier.MethodsThis observational study investigated the prevalence of metabolic syndrome as defined by the International Diabetes Federation in all eligible participants (n = 247) attending a postpartum lifestyle intervention clinic from August 2018 to June 2021 at the Lyell McEwin Hospital in Adelaide, South Australia.ResultsA total of 89 (36%) participants met the criteria for metabolic syndrome at a mean follow up time of 7 months postpartum. Almost 90% of the cohort were abdominally obese, and over two thirds of the total cohort met at least two of the criteria for metabolic syndrome.ConclusionsWomen with a prior history of one of the common major pregnancy complications are at high risk of future cardiovascular and metabolic disease, with many showing either metabolic syndrome or multiple risk factors at only 7 months postpartum. The results indicate that follow-up within 1 year postpartum is an appropriate time to commence preventative strategies, as many women are already showing early signs of disease.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis

Aldridge

Pathirana

Wittwer

et al. 2022

Front. Cardiovasc. Med.

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“…This was a prospective observational study of the postpartum lifestyle clinic at the Lyell McEwin Hospital (LMH) [ 15 ]. The LMH is a public tertiary acute-care facility providing obstetric care, adult cardiac and intensive care services, and neonatal care for infants at ≥ 32 weeks’ gestation and located within the Northern Adelaide Local Health Network (NALHN), South Australia.…”

Section: Methodsmentioning

confidence: 99%

“…In Australia, there are very few postpartum follow-up services for this high-risk cohort. In 2018, the first nurse-practitioner led postpartum lifestyle clinic was introduced at a metropolitan hospital based in the northern suburbs of Adelaide, South Australia [ 15 ]. This outpatient service was developed using the Maternal Health Clinic clinical model and provides cardiometabolic risk screening and individualised lifestyle and risk reduction education for all women who experience a serious complication of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a nurse practitioner-led cardiovascular prevention clinic at reduction of metabolic syndrome following maternal complications of pregnancy: a preliminary analysis

Aldridge

Pathirana

Wittwer

et al. 2022

Diabetol Metab Syndr

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Aim Maternal complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, preterm labour, and placental abruption, are associated with increased risk of future cardiometabolic disease. Lifestyle interventions that focus on preventative strategies for this young, high-risk population of women may assist in cardiometabolic disease risk reduction. The aim of this preliminary registry analysis was to observe the change in maternal metabolic syndrome status after receiving a nurse practitioner-led lifestyle intervention delivered soon after a complicated pregnancy. Method This preliminary analysis included 64 eligible women who had attended both baseline (approximately 6 months postpartum) and review (approximately eighteen months postpartum) appointments at the postpartum lifestyle clinic after an index pregnancy complicated by at least one maternal complication of pregnancy. Metabolic syndrome status at both appointments was assessed. Results At the baseline appointment, 22 (34.4%) women met the criteria for metabolic syndrome. This number reduced at the review appointment to 19 (29.7%). This difference was not statistically significant. There were some modest improvements in the individual cardiometabolic risk factors, as well as marked improvements in the women who had recovered from metabolic syndrome over twelve months. Conclusion There was a high percentage of metabolic syndrome present early in the postpartum period. The results of this preliminary analysis highlight the importance of continuing preventative care and ongoing research for this group of high-risk women.

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Knowledge and care regarding long-term cardiovascular risk after hypertensive disorders of pregnancy and gestational diabetes

Pfaller,

Busvine,

Rosenauer

et al. 2024

Wien Klin Wochenschr

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Summary Background Adverse pregnancy outcomes (APO), such as preeclampsia (PE) and gestational diabetes (GDM) are substantial risk factors for cardiovascular disease (CVD) later in life. Identifying these high-risk female individuals during pregnancy offers the possibility of preventing long-term CVD and chronic kidney disease via a structured therapeutic and surveillance plan. We aimed to evaluate the current practice of postpartum care in women after APO and the impact on the women’s awareness about their future risk for CVD. Methods Women diagnosed with PE and GDM at the University Hospital of St. Poelten/Lilienfeld between 2015–2020 were identified and participated in a structured telephone interview about postpartum medical care and knowledge about the impact of APOs on long-term cardiovascular health. Results Of 161 out of the 750 women contacted, 29% (n = 46) were diagnosed with PE and 71% (n = 115) with GDM. One third of all women and up to 44% of women diagnosed with PE, were unaware that APOs are related to CVD. Women diagnosed with PE were less likely to receive postpartum care information than those with GDM (30.4% vs. 49.6%, p = 0.027), and only one third of all women after APOs were counselled by a physician or healthcare professional. Of the women 50% received recommendations regarding lifestyle changes after delivery; significantly more women with GDM than women with PE (54% vs. 37%, p = 0.05). Only 14% had at least one long-term follow-up. Conclusion This study identified a significant deficit of structured postpartum care and a lack of awareness among women after APO and their healthcare providers about the increased risk of long-term CVD.

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A Protocol for Nurse-Practitioner Led Cardiovascular Follow-Up After Pregnancy Complications in a Socioeconomically Disadvantaged Population

Cited by 5 publications

References 38 publications

Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis

Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis

Effectiveness of a nurse practitioner-led cardiovascular prevention clinic at reduction of metabolic syndrome following maternal complications of pregnancy: a preliminary analysis

Knowledge and care regarding long-term cardiovascular risk after hypertensive disorders of pregnancy and gestational diabetes

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