Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Weill Cornell Medicine, 525 East 68th Street Box 122, New York, NY, 10065, USA.
Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Curr Hypertens Rep. 2020 Sep 17;22(11):92. doi: 10.1007/s11906-020-01102-9.
Obstetrical complications including indicated preterm birth (PTB), hypertension (HTN), IUGR, and GDM are risk factors for future cardiovascular disease. To identify patients at risk, the American Heart Association recommends obtaining a detailed obstetric history. Our objective was to determine if non-OB-GYN physicians-in-training obtain an obstetric history when assessing a risk profile for cardiovascular disease and to identify differences based on level of training. In 2019, an anonymous survey was distributed to trainees in internal medicine, cardiology, endocrinology, nephrology, and neurology. Subjects were queried about frequency of asking a history of PTB, IUGR, GDM, and HTN in pregnancy. Survey options were always/frequently/sometimes/rarely/never and were categorized into two groups: "ask" (always/frequently/sometimes) vs. "do not ask" (rarely/never). Comparisons between specialties and levels of training were made using chi-square and Fisher's exact test. Comparisons within subjects were made using McNemar's test.
The response rate was 64% (210 total possible participants), including 98 internal medicine residents and 37 fellows in cardiology (21), endocrinology (3), nephrology (8), and neurology (5). Asking about medical complications (HTN + GDM) was significantly more common than asking about OB complications (PTB + IUGR) (p < 0.001). Internal medicine residents were less likely than subspecialty fellows to ask about HTN (31% vs. 70%; p < 0.001). There were no differences in likelihood of eliciting OB history based on PGY level. An OB history can identify risk factors for cardiovascular morbidity. Our data demonstrates that physicians caring for women lack awareness on the association between complications in pregnancy and cardiovascular health.
产科并发症，包括有指征的早产（PTB）、高血压（HTN）、胎儿生长受限（IUGR）和妊娠期糖尿病（GDM），是未来心血管疾病的危险因素。为了识别高危人群，美国心脏协会建议获取详细的产科病史。我们的目的是确定非妇产科住院医师在评估心血管疾病风险概况时是否会获取产科病史，并根据培训水平确定差异。2019 年，我们向内科、心脏病学、内分泌学、肾脏病学和神经病学住院医师发放了一份匿名调查。询问了他们在评估心血管疾病风险概况时询问 PTB、IUGR、GDM 和妊娠高血压病史的频率。调查选项为总是/经常/有时/很少/从不，并分为两组：“询问”（总是/经常/有时）和“不询问”（很少/从不）。使用卡方检验和 Fisher 确切检验比较不同专业和培训水平之间的差异。使用 McNemar 检验比较受试者内部的差异。
回复率为 64%（210 名可能的参与者），包括 98 名内科住院医师和 37 名心脏病学（21 名）、内分泌学（3 名）、肾脏病学（8 名）和神经病学（5 名）研究员。询问医疗并发症（HTN+GDM）比询问产科并发症（PTB+IUGR）更为常见（p<0.001）。内科住院医师询问 HTN 的可能性低于亚专科研究员（31% vs. 70%；p<0.001）。PGY 水平对获取 OB 病史的可能性没有影响。产科病史可以识别心血管发病率的危险因素。我们的数据表明，照顾女性的医生对妊娠并发症与心血管健康之间的关联缺乏认识。
