Nagraj Shobhana, Kennedy Stephen H, Norton Robyn, Jha Vivekananda, Praveen Devarsetty, Hinton Lisa, Hirst Jane E
Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.
The George Institute for Global Health, Oxford, United Kingdom.
Front Cardiovasc Med. 2020 Mar 20;7:40. doi: 10.3389/fcvm.2020.00040. eCollection 2020.
Cardiometabolic disorders (CMDs), including ischemic heart disease, stroke and type 2 diabetes are the leading causes of mortality and morbidity in women worldwide. The burden of CMDs falls disproportionately on low and middle-income countries (LMICs), placing substantial demands on already pressured health systems. Cardiometabolic disorders may present up to a decade earlier in some LMIC settings, and are associated with high-case fatality rates. Early identification and ongoing postpartum follow-up of women with pregnancy complications such as hypertensive disorders of pregnancy (HDPs), and gestational diabetes mellitus (GDM) may offer opportunities for prevention, or help delay onset of CMDs. This mini-review paper presents an overview of the key challenges faced in the early identification, referral and management of pregnant women at increased risk of CMDs, in low-resource settings worldwide. Evidence-based strategies, including novel diagnostics, technology and innovations for early detection, screening and management for pregnant women at high-risk of CMDs are presented. The review highlights the key research priorities for addressing cardiometabolic risk in pregnancy in low-resource settings.
心脏代谢紊乱（CMD），包括缺血性心脏病、中风和2型糖尿病，是全球女性死亡和发病的主要原因。CMD的负担在低收入和中等收入国家（LMIC）中分布不均，给本就面临压力的卫生系统带来了巨大需求。在一些LMIC环境中，心脏代谢紊乱可能提前十年出现，并且与高病死率相关。对患有妊娠并发症（如妊娠高血压疾病（HDP）和妊娠期糖尿病（GDM））的妇女进行早期识别和产后持续随访，可能提供预防机会，或有助于延缓CMD的发病。本综述文章概述了全球资源匮乏地区在早期识别、转诊和管理有CMD风险增加的孕妇时面临的关键挑战。还介绍了基于证据的策略，包括用于早期检测、筛查和管理有CMD高风险孕妇的新型诊断方法、技术和创新。该综述强调了在资源匮乏地区应对妊娠心脏代谢风险的关键研究重点。
