Trends in Cardiovascular Health Counseling Among Postpartum Individuals

Abstract

ImportancePoor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals.ObjectiveTo determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit.Design, Setting, and ParticipantsSerial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]).ExposuresTotal number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs).Main Outcomes and MeasuresAnnual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year.ResultsFrom 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, −1.4% [95% CI, −1.8% to −1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, −0.7% [95% CI, −1.3% to −0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, −0.8% [95% CI, −1.3% to −0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors.Conclusions and RelevanceApproximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.

Adverse Pregnancy Outcomes and Predicted 30-Year Risk of Maternal Cardiovascular Disease 2–7 Years After Delivery

“…Currently available evidence-based options to reduce atherosclerotic CVD risk include exercise, weight control, smoking prevention and cessation, and early identification and treatment of elevated lipids, high blood pressure, and diabetes. 12 However, in a recent analysis using data from the Pregnancy Risk Assessment Monitoring System between 2016 and 2010, Cameron et al 37 showed that only 60% of individuals with atherosclerotic CVD risk factors or adverse pregnancy outcomes received cardiovascular health counseling at their postpartum visit, and this frequency has not increased over time. Systems-based changes for ongoing cardiometabolic risk screening and prevention include improving the transition from obstetric to primary care, flagging of adverse pregnancy outcomes in the electronic health record for follow-up, electronic communication across clinicians, and multidisciplinary postpartum transitional clinics.…”

Chronic Hypertension and the Risk of Readmission for Postpartum Cardiovascular Complications

“…45 Of those who attend their postpartum visits, less than 60% receive counseling on cardiovascular health. 46…”

Cardiovascular Health in the Postpartum Period

“…APOs should be highlighted in patient-clinician discussions as risk-enhancing factors for long-term CVD risk, even if risk factor levels have normalized. However, data from the Pregnancy Risk Assessment Monitoring System demonstrated that only about 60% of postpartum individuals reported receiving counseling on CVH at their postpartum visit, even among those with poor CVH or who experienced an APO . Counseling discussions must be patient-centered and consider the structural, social, and economic contexts that influence behavior.…”