ABSTRACT
INTRODUCTION: Epidemiologic studies suggest that pregnancy complications such as preeclampsia, gestational diabetes, preterm delivery and low birth weight independently increase maternal risk for future development of cardiovascular disease. OBJECTIVES: To further investigate whether preeclampsia, gestational diabetes, and adverse obstetrical outcomes such as placental abruption, intrauterine growth restriction and preterm delivery, are independent risk factors for longterm cardiovascular disease. METHODS: This was a case-control study where 252 parous women (cases) with coronary artery disease were matched with a parous woman within 5 years of age with no known coronary artery disease (controls). Participants were recruited from the Royal Alexandra Hospital in cardiac catheterization lab recovery room in Edmonton, Canada. Women with significant angiographic coronary artery stenosis were eligible as cases and those without were eligible as controls. Participants were interviewed on their pregnancy histories and traditional cardiovascular risk factors, such as hypertension, diabetes etc. Descriptive statistics, chi-square tests and conditional regression analysis were performed. RESULTS: We recruited 244 cases and 246 controls. The average age was 66.3 and 65.8 respectively. Cases were more likely obese, had more pregnancies as well as traditional cardiovascular risk factors than controls. Adverse pregnancy outcomes were similar between the two groups except gestational hypertension. However, it was not statistically significant in the conditional logistic regression model. Independent risk factors for future cardiovascular diseases were: dyslipidemia (OR 12.8), hypertension (3.0), and being a current (OR 7.4) or former smoker (1.8). Adverse pregnancy outcomes CONCLUSION: In this study, adverse pregnancy outcomes were not independently associated with cardiovascular disorders. Our study was limited by recall bias, and ascertainment of diagnosis.Our study supports that dyslipidemia, hypertensiion and smoking increase future cardiovascular disease. Further studies are needed to examine a postpartum intervention model to proactively manage cardiovascular risk factors, such as lipids, in these at-risk women.
ABSTRACT
INTRODUCTION: Preeclampsia (PEC) is a well-established risk factor for the development of future premature cardiovascular disease (CVD). However, women with PEC are not routinely counselled about these longterm risks, nor are their risk factors regularly assessed or treated for prevention of CVD. An interdisciplinary PPPEC clinic was recently established at the University of Alberta in order to address patient education and CVD risk factor management. OBJECTIVES: (1) To describe the implementation of a novel interdisciplinary clinic for postpartum women with PEC designed to both educate women of their CVD risk and manage their risk factors. (2) To describe our one-year experience with this clinic, identifying attendance issues common to postpartum clinics. METHODS: We performed a retrospective chart review using data obtained from standardized clinic booking lists. From these records, we extracted the following information: number of referrals, attendance dates (including adherence to visit) and patient demographics. Descriptive statistics were used to summarize patient demographics and percentages of missed visits were calculated. RESULTS: PPPEC Clinic Implemenation: All patients who attend this PPPEC clinic received education on PEC, its implications for future vascular health, and evidence-based strategies for CVD risk reduction through both a slide presentation, educational handouts as well as individualized CVD risk assessment by the interdisciplinary team (Obstetric Internist, nurse practitioner, pharmacist and dietician). Next, specific patient-directed lifestyle modification goals were developed in the form of an "Action Plan" for each CVD risk factor: blood pressure, cholesterol, glucose intolerance, physical activity level, weight, and smoking. These goals were reviewed at each follow-up visit. PPPEC Clinic Experience: From Sept 2010 to Feb 2012, there were 123 appointments in this bi-weekly clinic (63 new consults and 60 follow ups). The women's mean age was 29.4 years (range 17-43). Seventy-four percent of scheduled apointments were attended. Of those that were missed, half were initial consultations and halfwere follow-up appointments. CONCLUSION: This interdisciplinary PPPEC addresses an important gap in clinical care for CVD prevention for these high-risk women. This study identified suboptimal attendance of scheduled postpartum visits. Future plans include: (1) identifying barriers to postpartum clinic attendance and strategies to overcome them, (2) examining the effectiveness of the educational and clinical intervention model in reducing cardiovascular risk factors in these women.
