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This statement from the American Heart Association (AHA) discusses the impact of adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, small-for-gestational-age delivery, placental abruption, and pregnancy loss, on the development of cardiovascular disease (CVD) risk factors and future CVD. The statement highlights the need for clinicians to take note of APOs when evaluating CVD risk in women and to consider implementing CVD prevention strategies, such as lifelong lifestyle modifications, in women with APOs. The authors discuss factors that may reduce (lactation and breastfeeding) or increase (racial and ethnic health disparities) CVD risk and consider areas for future research, such as the role of pharmacological interventions in women with APOs. Changes in healthcare systems and policy to address CVD care for women with APOs are also discussed.
This AHA statement comprehensively details the relationships between APOs and CVD risk in women and highlights the importance of considering APOs when assessing a woman's CVD risk.
This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman's risk of developing cardiovascular disease (CVD) risk factors and of developing subsequent CVD (including fatal and nonfatal coronary heart disease, stroke, peripheral vascular disease, and heart failure). This statement highlights the importance of recognizing APOs when CVD risk is evaluated in women, although their value in reclassifying risk may not be established. A history of APOs is a prompt for more vigorous primordial prevention of CVD risk factors and primary prevention of CVD. Adopting a heart-healthy diet and increasing physical activity among women with APOs, starting in the postpartum setting and continuing across the life span, are important lifestyle interventions to decrease CVD risk. Lactation and breastfeeding may lower a woman's later cardiometabolic risk. Black and Asian women experience a higher proportion APOs, with more severe clinical presentation and worse outcomes, than White women. More studies on APOs and CVD in non-White women are needed to better understand and address these health disparities. Future studies of aspirin, statins, and metformin may better inform our recommendations for pharmacotherapy in primary CVD prevention among women who have had an APO. Several opportunities exist for health care systems to improve transitions of care for women with APOs and to implement strategies to reduce their long-term CVD risk. One proposed strategy includes incorporation of the concept of a fourth trimester into clinical recommendations and health care policy.