Improving Documentation of Adverse Pregnancy Outcomes and Associated Cardiovascular Risk in Women

Park, Ki; Egerman, Robert; Sattari, Maryam; N, Kaufman

doi:10.1016/s0735-1097(19)32362-9

Cited by 4 publications

(5 citation statements)

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“…Our findings are consistent with survey studies conducted in the United States (US), where a high proportion of women experienced an adverse pregnancy outcome increasing their CVD risk, yet only 15% had their obstetric history documented [3]. Similarly, a survey study investigating physician's knowledge of pregnancy complications and their link to vascular disease, found that 56% of internists and 23% of obstetrician-gynaecologists did not know of the association between pre-eclampsia and future CVD.…”

Section: Discussionsupporting

confidence: 88%

“…The immense importance of taking an obstetric history in our female cardiac patients is now apparent. Yet awareness of pregnancy complications as representing increased cardiovascular risk is astoundingly low [3]. Even when women have significant pregnancy complications such as gestational diabetes, hypertension or pre-eclampsia, documentation of these additional CVD risk factors in their past-medical history is poor [4].…”

Section: Introductionmentioning

confidence: 99%

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Previous Pre-Eclampsia, Gestational Diabetes and Hypertension Place Women at High Cardiovascular Risk: But Do We Ask?

Aslam

Perera

Watts

et al. 2021

Heart, Lung and Circulation

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BackgroundWomen who experience vascular complications of pregnancy, including pre-eclampsia, hypertension and diabetes, are at increased risk of coronary artery disease (CAD). Yet patients and their medical providers have low awareness of the significance of these 'non-traditional' cardiovascular risk factors. We aimed to determine the prevalence and medical provider awareness of pregnancy-related cardiovascular risk factors in women with CAD. MethodsWomen aged 18-70 years treated with percutaneous coronary intervention (PCI) across three tertiary hospitals were invited to participate in a pregnancy-related telephone interview at 12 months post-PCI. Electronic medical records (EMR) were retrospectively reviewed for documentation of pregnancy-related cardiovascular risk factors in the 12 months prior to, and including, the PCI admission. ResultsA total of 102 women (mean age 59.867.7 years) underwent PCI for CAD and completed the pregnancy history questionnaire. Approximately three-quarters (73.5%, 75/102) of women had been pregnant, of which 25.3% (19/75) had experienced vascular complications consisting of pre-eclampsia 31.5% (6/19), gestational diabetes 36.8% (7/19), and gestational hypertension 73.6% (14/19). Documentation of traditional CVD risk factors occurred in 209/211 episodes of emergency or cardiology contact (99.1%), while documentation of 'non-traditional' pregnancy-related cardiovascular risk factors occurred in 0/211 episodes of emergency or cardiology contact. ConclusionMore than a quarter of women treated with PCI for CAD had experienced a past pregnancy-related vascular complication. Despite vascular complications of pregnancy predicting future CAD, medical providers were not obtaining a history of these 'non-traditional' cardiovascular risk factors.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Previous Pre-Eclampsia, Gestational Diabetes and Hypertension Place Women at High Cardiovascular Risk: But Do We Ask?

Aslam

Perera

Watts

et al. 2021

Heart, Lung and Circulation

View full text Add to dashboard Cite

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“…History of PID may serve as a marker for the future development of hypertension and diabetes mellitus (type 2), two prominent risk factors for CVD. The integration of the female reproductive history into routine primary care consultations may impact CVD risk factor screening [ 45 ]. Areas that warrant further research include: the variability in cardiometabolic risk based on the type of microbe causing PID or severity of PID.…”

Section: Discussionmentioning

confidence: 99%

Risk of cardiometabolic outcomes among women with a history of pelvic inflammatory disease: a retrospective matched cohort study from the UK

et al. 2023

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Introduction To describe the incidence and prevalence of pelvic inflammatory disease (PID) and to estimate the risk of cardiometabolic outcomes among women with PID compared to women without PID. Methods A UK retrospective matched cohort study using data from The Health Improvement Network. To assess cardiometabolic risk, women (aged ≥ 16 years) with PID were compared to matched controls without PID. Annual prevalence and incidence of PID (1998–2017) were estimated among women aged 16–50 years using annual cross-sectional and cohort analyses, respectively. Adjusted hazard ratios (aHR) and 95% CI for cardiometabolic outcomes were estimated using Cox proportional hazards models. The primary outcome was composite cardiovascular disease (CVD) and its subtypes, including ischaemic heart disease (IHD), heart failure (HF) and cerebrovascular disease. Secondary outcomes were hypertension, and type 2 diabetes mellitus (T2DM). Results Among the 715 recorded composite CVD events, the crude incidence rate per 1000 person-years was 1.5 among women with history of PID compared to 1.3 in matched controls. Compared to women without PID (N = 73,769), the aHRs for cardiometabolic outcomes among women with PID (N = 19,804) were: composite CVD 1.10 (95% CI 0.93–1.30); IHD 1.19 (95% CI 0.93–1.53); cerebrovascular disease 1.13 (95% CI 0.90–1.43); HF 0.92 (95% CI 0.62–1.35) hypertension 1.10 (95% CI 1.01–1.20); and T2DM 1.25 (95% CI 1.09–1.43). The prevalence (per 10,000 population) of PID was 396.5 in 1998 and 237 in 2017. The incidence (per 10,000 person-years) of PID was 32.4 in 1998 and 7.9 in 2017. Conclusion There was no excess risk of composite CVD or its subtypes among women with history of PID compared to matched controls. Findings from our study suggest that history of PID was associated with an increased risk of hypertension and type 2 diabetes mellitus, two major risk factors for CVD. Additional studies are required to support these findings.

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“…Similarly, only 62% of the participants in our sample who self-reported a pregnancy complication in the survey had it recorded in their EMR. Improvement of documentation of pregnancy complications in the EMR has the potential to ensure greater physician awareness of patient history and bridge transitions in care (18,26).…”

Section: Discussionmentioning

confidence: 99%

“…Improvement of documentation of pregnancy complications in the EMR has the potential to ensure greater physician awareness of patient history and bridge transitions in care. 18 , 25 …”

Section: Discussionmentioning

confidence: 99%

The prevalence of documented cardiovascular-related pregnancy complications: cross-sectional study in an academic primary care centre

et al. 2022

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BackgroundPregnancy and the postpartum period offer a unique opportunity to identify patients with, often unrecognized, risk factors leading to premature cardiovascular disease (CVD).AimThis study investigates self-reported prevalence of CV-related pregnancy complications and its documentation in Electronic Medical Records (EMRs) in an Academic Family Health Team.Design & SettingA retrospective cross-sectional survey conducted from 2016 to 2017 in an Academic Family Health Team.MethodsThe survey assessed self-reported pregnancy complications and obstetric history of adult women. EMRs of respondents who provided consent were appraised for documented pregnancy complications, and management of traditional cardiovascular risk factors post pregnancy.ResultsOut of the 211 respondents, 28.4% (n=60) had at least one pregnancy complication reported in the survey and/or in the EMR, of which 67.4% had the complication documented in their EMR. The most prevalent complications were preterm birth (12%), hypertensive disorders of pregnancy (HDP) (10%) and gestational diabetes mellitus (GDM) (7%). Twenty-nine per cent of the patients with GDM had a 75 g oral glucose tolerance test result documented post-pregnancy. Of those with HDP, 36% had a body mass index and 50% had a blood pressure measurement recorded after delivery.ConclusionThere is a significant lack of documentation of pregnancy-related cardiovascular risk factors and subsequent management introducing a missed opportunity for early cardiovascular intervention. Adequate documentation of pregnancy complications in the EMR and better transitions in care between obstetric and primary care teams could potentially enable clinicians to intervene early and better manage women at increased risk of CVD.

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Improving Documentation of Adverse Pregnancy Outcomes and Associated Cardiovascular Risk in Women

Cited by 4 publications

References 0 publications

Previous Pre-Eclampsia, Gestational Diabetes and Hypertension Place Women at High Cardiovascular Risk: But Do We Ask?

Previous Pre-Eclampsia, Gestational Diabetes and Hypertension Place Women at High Cardiovascular Risk: But Do We Ask?

Risk of cardiometabolic outcomes among women with a history of pelvic inflammatory disease: a retrospective matched cohort study from the UK

The prevalence of documented cardiovascular-related pregnancy complications: cross-sectional study in an academic primary care centre

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