The Maternal Health Clinic: Improving women's cardiovascular health.

Women's cardiovascular health is a national priority that should be addressed through improving cardiovascular awareness and prevention. Given the costs of treating cardiovascular disease and screening for it, novel and innovative ways to identify women who should undergo risk screening and intervention, including lifestyle modification, is critical to achieve this goal. Pregnancy is seen as a vascular stress test in that the development of common pregnancy complications has been shown to predict a woman's risk of premature cardiovascular disease and cardiovascular disease-related mortality. Therefore, pregnancy and the postpartum period provide a new early window of opportunity to identify risk factors for the majority of women to improve their long-term health. We have translated the research findings into the Maternal Health Clinic for health maintenance and disease prevention. Women who develop one of the pregnancy-related cardiovascular risk indicators are referred for screening, counseling, and lifestyle modification. We have reported that over half of the women referred to the Maternal Health Clinic, in comparison to women who have a normal pregnancy outcome, have a high lifetime cardiovascular disease risk and three times the risk to meet the criteria for the metabolic syndrome. If these women had not attended our clinic and received early screening and intervention, they may not have been identified as having underlying risk factors until much later in life. Intervening and management later in life, when there is a potentially greater burden of atherosclerosis, does not reduce cardiovascular disease risk to the same extent as maintaining favorable risk factor levels throughout adulthood. Pregnancy complications and the postpartum period are a new early window of opportunity to reliably identify women who should undergo cardiovascular risk screening, and management that may improve subsequent pregnancy outcomes and prevent cardiovascular disease.