A recent American Heart Association (AHA) scientific statement provides an updated summary of evidence that adverse pregnancy outcomes (APOs) are associated with increased risk of developing cardiovascular disease (CVD), including coronary heart disease and ischemic stroke. They also are associated with developing future CVD risk factors, such as diabetes, dyslipidemia, or hypertension.1
Adverse pregnancy outcomes include gestational diabetes, hypertensive disorders of pregnancy, preterm delivery, and pregnancy loss, among other conditions (Table 1). They occur in 10-15% of pregnancies and may arise due to maternal physiological changes.1 While APOs are not included in CVD risk calculators, some are considered by the AHA to be CVD risk-enhancing factors, which may impact decisions for statin use for primary prevention.2,3 Further study is needed on the use of pharmacotherapy in primary prevention of CVD and CVD risk factors in patients with APOs, including how APOs affect risk stratification.1
Pivoting to an enhanced postpartum period, or “fourth trimester,” provides an opportunity for clinicians to emphasize the cardiometabolic benefits of breastfeeding, heart-healthy diet, physical activity, and smoking cessation as part of patient care for those with cardiovascular risk.4 The American College of Obstetricians and Gynecologists offers resources to support mothers of newborns in making these changes.
- Parikh NI, Gonzalez JM, Anderson CAM, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association. Circulation. 2021;143:e902–e916. doi: 10.1161/CIR.0000000000000961.
- American College of Cardiology. ASCVD Risk Estimator Plus. https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/. Updated March 2019. Accessed May 27, 2021.
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1082–e1143. DOI: 10.1161/CIR.0000000000000625.
- The American College of Obstetricians and Gynecologists: Presidential Task Force on Redefining the Postpartum Visit Committee on Obstetric Practice. Optimizing Postpartum Care. https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2018/05/optimizing-postpartum-care.pdf. Published May 2018. Accessed May 27, 2021.