Patients’ understanding of long-term cardiovascular risks and associated health-seeking behaviours after pre-eclampsia

Abstract

ObjectiveThe lifelong risks of cardiovascular disease following hypertensive disorders of pregnancy are well described. Awareness of these risks and associated health-seeking behaviours among affected individuals remains unclear. We aimed to assess participants’ knowledge of their cardiovascular disease risk and relevant health-seeking behaviours following a pregnancy affected by preeclampsia or gestational hypertension.MethodsWe undertook a single-site, cross-sectional cohort study. The target population included individuals who birthed at a large tertiary referral centre in Melbourne, Australia, between 2016 and 2020, and were diagnosed with gestational hypertension or pre-eclampsia. Participants completed a survey assessing pregnancy details, medical comorbidities, knowledge of future risks and health-seeking behaviours post-pregnancy.Results1526 individuals met inclusion criteria and 438 (28.6%) completed the survey. Of these, 62.6% (n=237) were unaware of their increased risk of cardiovascular disease following a hypertensive disorder of pregnancy. Participants who reported awareness of their increased risk were more likely to have annual blood pressure monitoring (54.6% vs 38.1%, p<0.01), and at least one assessment of blood cholesterol (p<0.01), blood glucose (p=0.03) and renal function (p=0.01). Participants who were aware were more likely to be taking antihypertensive medication (24.5% vs 6.6%, p<0.01) since pregnancy, compared with those who were unaware. There were no differences between groups in diet, exercise or smoking habits.ConclusionAmong our study cohort, risk awareness was associated with increased health-seeking behaviours. Participants who were aware of their increased risk of cardiovascular disease were more likely to have regular cardiovascular risk factor assessments. They were also more likely to be taking antihypertensive medication.

Women's Knowledge of Future Cardiovascular Risk Associated With Complications of Pregnancy: A Systematic Review

“…Two potentially eligible studies were excluded following 2 unsuccessful attempts to contact all listed authors to obtain missing information. Overall, 15 studies were included in the review, 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 14 in English and 1 in Spanish. 33

Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) study flow diagram.

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“…Studies were conducted in all World Health Organization’s World Regions, 37 except for the Eastern Mediterranean Region, and were published from 2011 to 2023. Three studies were randomized controlled trials that used questionnaires to assess knowledge (Likert-type questions); 31 , 32 , 36 5 were qualitative in design using semistructured interviews and focus groups discussions; 23 , 26 , 28 , 29 , 30 6 were observational cross-sectional studies using online surveys (when reported, using multiple-choice questions); 22 , 24 , 25 , 27 , 34 , 35 and 1 was an educational intervention with a pre-post design using a questionnaire (multiple-choice questions) to assess knowledge. 33 The quality of each study is also shown in Table 1 .…”

“…All studies included women with a recent or past diagnosis of HDP, including 7 studies focused on preeclampsia. 24 , 26 , 27 , 28 , 30 , 32 , 36 Six studies also included women with a current diagnosis or a history of gestational diabetes, 22 , 23 , 24 , 25 , 29 , 33 and 3 women with a history of premature birth. 22 , 23 , 25 The mean age of participants was 30 years (age range reported as < 18 to > 45 years).…”

“…As shown in Table 1 , a total of 10 studies used online surveys or questionnaires to measure knowledge outcomes, ranging from 1 to 51 question items. 22 , 24 , 25 , 27 , 31 , 32 , 33 , 34 , 35 , 36 No studies report classification criteria of questionnaire scores. Only 2 studies reported assessment of psychometric properties of the educational tools: 1 reported the assessment of content validity, 27 and 1 reported face validity 34 ; however, numerical measurements of validity were not reported following Terwee et al.’s criteria.…”

“… Atkinson et al. 24 (2023) Australia Observational cross-sectional Tertiary care hospital 4/5 Women with a history of preeclampsia or gestational diabetes n = 438 Age = NR Ethnicity = NR Wk postpartum = NR Type of birth = NR Severity = NR Women’s knowledge of CVD risk following a pregnancy affected by preeclampsia or gestational hypertension. Survey (51 items) Psychometric properties were not assessed.…”