Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women

O’Kelly, Anna C.; Michos, Erin D.; Shufelt, Chrisandra; Vermunt, Jane; Minissian, Margo; Quesada, Odayme; Smith, Graeme N.; Rich‐Edwards, Janet W.; Garovic, Vesna D.; Khoudary, Samar R. El; Honigberg, Michael C.

doi:10.1161/circresaha.121.319895

Cited by 158 publications

(147 citation statements)

References 237 publications

(314 reference statements)

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“…Careful planning of future pregnancy is particularly imperative for women with pre-existing cardiac conditions that require teratogenic pharmacotherapy such as warfarin or ACE inhibitors. Shared decision-making regarding the method and duration of contraception should take place between the patient and her cardio-obstetrics team during the fourth trimester and regularly thereafter [ 91 ].…”

Section: A Time For Transitions In Care: Models For Improvementmentioning

confidence: 99%

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

Choi

Timlin

Varma

et al. 2022

Curr Cardiovasc Risk Rep

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Purpose of Review The “fourth trimester” concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women’s cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester. Recent Findings A seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness. Summary Development of a comprehensive postpartum care plan with careful consideration of each patient’s risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.

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Section: A Time For Transitions In Care: Models For Improvementmentioning

confidence: 99%

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

Choi

Timlin

Varma

et al. 2022

Curr Cardiovasc Risk Rep

Self Cite

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“…Despite the prevalence of chronic conditions across the life span, less is known about the adoption of digital health use in women. Previous studies have focused on digital health use during the perinatal period or on pregnancy-related chronic conditions [13][14][15][16][17]. Furthermore, other studies merely compare digital health use between men and women without investigating the distinct patterns of digital health use among women [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

The Use of Digital Health Tools for Health Promotion Among Women With and Without Chronic Diseases: Insights From the 2017-2020 Health Information National Trends Survey

Ajayi¹,

Wachira²,

Onyeaka³

et al. 2022

JMIR Mhealth Uhealth

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Background In the United States, almost 90% of women are at risk of at least one chronic condition. However, the awareness, management, and monitoring of these conditions are low and present a substantial public health problem. Digital health tools can be leveraged to reduce the alarmingly high rates of chronic condition–related mortality and morbidity in women. Objective This study aimed to investigate the 4-year trend of digital health use for health promotion among women with chronic conditions in the United States. Methods Data for this study were obtained from the 2017 to 2020 iterations of the Health Information Trends Survey 5. Separate weighted logistic regression models were conducted to test the unadjusted and adjusted association of the study variables and each digital health use. The 95% CI, adjusted odds ratio (aOR), and P value (.05) were reported. Analysis was conducted using Stata 17 software. Results In total, 8573 women were included in this study. The weighted prevalence of the use of a smartphone or tablet for various activities were as follows: track health goals, 50.3% (95% CI 48.4%-52.2%; 3279/7122); make a health decision, 43.6% (95% CI 41.9%-45.3%; 2998/7101); and discuss with a provider, 40% (95% CI 38.2%-41.8%; 2834/7099). In the preceding 12 months, 33% (95% CI 30.9%-35.2%; 1395/4826) of women used an electronic wearable device, 18.7% (95% CI 17.3%-20.2%; 1532/7653) shared health information, and 35.2% (95% CI 33.2%-37.3%; 2262/6349) sent or received an SMS text message with a health professional. Between 2017 and 2020, the weighted prevalence of having 0, 1, and multiple chronic conditions were 37.4% (2718/8564), 33.4% (2776/8564), and 29.3% (3070/8564), respectively. However, slightly above half (52.2%, 95% CI 0.50%-0.53%; 4756/8564) of US women reported having at least one chronic disease. Women with multiple chronic conditions had higher odds of using their tablet or smartphone to achieve a health-related goal (aOR 1.43, 95% CI 1.16-1.77; P=.001) and discuss with their provider (aOR 1.55 95% CI 1.20-2.00; P=.001) than those without any chronic conditions. Correspondingly, in the past 12 months, the odds of using an electronic wearable device (aOR 1.40, 95% CI 1.00-1.96; P=.04), sharing health information (aOR 1.91, 95% CI 1.46-2.51; P<.001), and communicating via SMS text messaging with a provider (aOR 1.31, 95% CI 1.02-1.68; P=.03) were significantly higher among women with chronic conditions than those without a chronic condition. Conclusions This study suggests that women with chronic conditions accept and integrate digital health tools to manage their care. However, certain subpopulations experience a digital disconnect that may exacerbate existing health inequities. Implications for research and opportunities to leverage and integrate digital health tools to prevent, monitor, manage, and treat chronic conditions in women are discussed.

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“…Female-specific risk factors, both modifiable and not, should also be taken into consideration. Adverse pregnancy outcomes (i.e., gestational hypertension, preterm delivery, preeclampsia/eclampsia) are associated with increased long-term CV risk of the mother and the mechanism seems to be an altered inflammatory state which affects maternal vasculature ( 19 , 20 ). Lifetime estrogen exposure, early menarche and short reproductive life span in particular, represent another unmodifiable risk factor, as shown in a recent meta-analysis that highlights how a reproductive life span < 33 years is associated with higher rate of CVD events in midlife ( 21 ).…”

Section: Introduction: Patho-physiology Of Sex-related Differences In...mentioning

confidence: 99%

Quantitative and qualitative features of carotid and coronary atherosclerotic plaque among men and women

Onnis

Dessalvi

Cademartiri

et al. 2022

Front. Cardiovasc. Med.

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Cardiovascular diseases (CVDs), particularly ischemic heart disease (IHD) and stroke, present epidemiologically in a different way among sexes. The reasons of these sex-based differences should be delved into sex-specific cardiovascular (CV) risk factors and different mechanisms of atherosclerotic progression. Imaging techniques of both carotid and coronary atherosclerotic plaques represent a tool to demonstrate sex-related features which might be used to further and better assess CV risk of male and female population. The aim of this review is to evaluate current knowledge on sex-specific qualitative and quantitative plaque features of coronary and carotid atherosclerosis. We also discuss the clinical implication of a sex-based plaque phenotype, evaluated with non-invasive imaging techniques, such as CT-angiography and MRI-angiography, to stratify CV risk.

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Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women

Cited by 158 publications

References 237 publications

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

The Use of Digital Health Tools for Health Promotion Among Women With and Without Chronic Diseases: Insights From the 2017-2020 Health Information National Trends Survey

Quantitative and qualitative features of carotid and coronary atherosclerotic plaque among men and women

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