Many Postpartum Check-Ups Omit Discussion of Mom’s Heart Health

For many new moms in recent years, the 4- to 6-week postpartum check-up still lacked cardiovascular health (CVH) counseling, according to nationally representative survey data.

About 50% to 60% of these women reported receiving counseling on healthy eating, exercise, and postpartum weight loss after giving birth in the U.S. from 2016 through 2020, reported Sadiya Khan, MD, MSc, of Northwestern University in Chicago, and colleagues, after analyzing data from the CDC Pregnancy Risk Assessment Monitoring System (PRAMS) survey.

Over the years, there were “no meaningful differences or changes” in the prevalence of postpartum cardiovascular counseling in people with cardiovascular disease (CVD) risk factors, despite increasing awareness and disruptions related to the COVID-19 pandemic starting in 2020, for that matter, the authors wrote in JAMA.

“Our data show that reports of overall counseling are low. For people who have risk factors, lifestyle counseling during this critical time is a first step to reducing long-term risk of heart disease,” stressed co-author Natalie Cameron, MD, MPH, also of Northwestern University, in a press release.

“In the midst of the growing public health crisis around maternal health, we also need to continue to increase awareness of the importance of long-term cardiovascular health monitoring and optimization among women with adverse pregnancy outcomes [APOs],” she added.

Indeed, risk factors and APOs increased during the study period. From 2016 through 2020, more women reported prepregnancy obesity (from 23.3% to 27.5%), gestational diabetes (from 8.0% to 10.1%), and hypertensive disorders of pregnancy (from 9.7% to 12.3%), Khan’s group reported.

What’s more, “substantial disparities in postpartum weight retention, diet, and long-term CVD risk persist,” they wrote.

They found that certain groups — namely those of non-Hispanic Black or American Indian/Alaska Native race, those with a high school education or less, and those lacking private insurance — were more likely to self-report CVH counseling at their postpartum visits.

“Therefore, while CVH counseling at the postpartum visit is an important first step, multilevel interventions are needed to equitably promote CVH during the peripartum period and beyond,” the authors wrote. They urged wide-ranging policies to address challenges with transportation, childcare, and insurance coverage, and better protocols for CVH counseling and CVD screening and surveillance during the peripartum period.

“We need to find ways to take advantage of this prime opportunity when we have a captive audience of people who are already in the doctor’s office, talking about their health at a critical juncture in life,” Khan said in the press release. “It is hard to create new opportunities. The fourth-trimester visit is an already-ready moment to prioritize maternal heart health.”

Cameron noted that “while the postpartum visit represents an opportunity to reach a large number of women, it is only the start.”

“Healthcare systems must improve continuity of care after pregnancy and help women find clinicians who can provide preventive care,” she said. “These can be obstetricians/gynecologists, primary care clinicians, or cardiologists, depending on the patient’s needs and the clinician’s expertise.”

Khan and colleagues conducted a cross-sectional study using PRAMS data that included patients 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 (i.e., obesity, diabetes, and hypertension), and adverse pregnancy outcomes.

They included 167,705 people weighted to represent over 8 million. Over three-quarters were 20-34 years old, most were white (60.2%), and a quarter were enrolled in Medicaid 2 to 6 months postpartum.

Receipt of postpartum CVH counseling was somewhat more likely among people with more CVD risk factors. Across groups, however, trends from 2016 to 2020 suggested stable to falling rates of counseling:

• Patients with no CVD risk factors: 56.2 to 52.8 per 100 individuals
• Those with one risk factor: 58.5 to 57.3 per 100 individuals
• Those with two or more risk factors: 61.9 to 59.8 per 100 individuals

“It is possible that CVD counseling may be underdocumented in the medical record and prevalence of CVH counseling in the present analysis may have been higher due to use of self-report. However, awareness of CVD risk by birthing individuals and by clinicians after an APO remains low, suggesting missed opportunities for CVH counseling during postpartum care, especially among individuals with prepregnancy CVD risk factors or APOs,” Khan’s team wrote.

Other limitations to their observational report included the exclusion of individuals without live births and some potential nonresponse bias.

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