Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare, Worcester, MA, USA.
Curr Atheroscler Rep. 2022 Jul;24(7):493-507. doi: 10.1007/s11883-022-01026-6. Epub 2022 May 7.
Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk factors who may be predisposed to CVD and offers a unique opportunity to not only recognize disease but also implement effective and long-lasting strategies for prevention.
Prevention begins before pregnancy, as preconception screening, counseling, and optimization of chronic diseases can improve maternal and fetal outcomes. Throughout pregnancy, women should maintain close follow-up, continued reevaluation of risk factors, with counseling when necessary. Continued healthcare engagement during the "fourth trimester," 3 months following delivery, allows clinicians to continue monitoring the evolution of chronic diseases, encourage ongoing lifestyle counseling, and connect women with primary care and appropriate specialists if needed. Unfortunately, this postpartum period represents a major care gap, as a significant proportion of most women do not attend their scheduled visits. Social determinants of health including decreased access to care and economic instability lead to increased risk factors throughout pregnancy but particularly play a role in poor compliance with postpartum follow-up. The use of telemedicine clinics and remote monitoring may prove to be effective interventions, bridging the gap between physicians and patients and improving follow-up for at-risk women. While many clinicians are beginning to understand the impact of CVD on women, screening and prevention strategies are not often implemented until much later in life. Pregnancy creates an opportunity to begin engaging women in cardiovascular protective strategies before the development of the disease.
在国际上，心血管疾病（CVD）是女性死亡的主要原因。随着 CVD 风险因素持续上升，早期识别和管理高血压、糖尿病和阻塞性睡眠呼吸暂停等慢性病对于预防至关重要。对于有 CVD 倾向的高危孕妇而言，妊娠本身就是一种自然的压力测试，不仅提供了识别疾病的机会，也为实施有效且持久的预防策略提供了契机。
预防应始于妊娠之前，通过孕前筛查、咨询和慢性病优化，可以改善母婴结局。整个妊娠期间，都应密切随访孕妇，持续重新评估风险因素，并在必要时提供咨询。在“第四孕期”（分娩后 3 个月）继续保持医疗保健参与，可以使临床医生继续监测慢性病的演变，鼓励持续的生活方式咨询，并在必要时将女性与初级保健医生和适当的专科医生联系起来。不幸的是，这一产后阶段代表着一个重大的护理缺口，因为很大一部分女性并未按照预约进行产后访视。健康的社会决定因素（包括医疗服务获取减少和经济不稳定）导致妊娠期间风险因素增加，尤其是在产后随访方面的依从性较差。远程医疗诊所和远程监测的使用可能被证明是有效的干预措施，可以在医生和患者之间架起桥梁，改善高危女性的随访效果。尽管许多临床医生开始了解 CVD 对女性的影响，但筛查和预防策略通常要到生命后期才会实施。妊娠为在疾病发生之前让女性开始参与心血管保护策略提供了机会。
