Department of Medicine (General Internal Medicine), Duke University School of Medicine, Durham, North Carolina, USA.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
J Womens Health (Larchmt). 2024 Jul;33(7):853-862. doi: 10.1089/jwh.2023.0461. Epub 2024 Mar 27.
Pregnancy-related cardiovascular (CV) conditions, including hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM), are associated with increased long-term CV risk. This retrospective cohort study defined the prevalence of HDP and GDM within a large, academic health system in the southeast United States between 2012 and 2015 and described health care utilization and routine CV screening up to 1-year following delivery among those with pregnancy-related CV conditions. Rates of follow-up visits and blood pressure, hemoglobin A1c (HbA1c), and lipid screening in the first postpartum year were compared by provider type and pregnancy-related CV condition. Of the 6027 deliveries included, 20% were complicated by HDP and/or GDM. Rates of pre-pregnancy CV risk factors were high, with a significantly higher proportion of pre-pregnancy obesity among women with HDP than in normal pregnancies. Those with both HDP/GDM had the highest rates of follow-up by 1-year postpartum, yet only half of those with any pregnancy-related CV condition had any follow-up visit after 12 weeks. Although most (70%) of those with HDP had postpartum blood pressure screening, less than one-third of those with GDM had a repeat HbA1c by 12 months. Overall, postpartum lipid screening was rare (<20%). There is a high burden of pregnancy-related CV conditions in a large U.S. academic health system. Although overall rates of follow-up in the early postpartum period were high, gaps in longitudinal follow-up exist. Low rates of CV risk factor follow-up at 1 year indicate a missed opportunity for early CV prevention.
妊娠相关心血管（CV）疾病，包括妊娠高血压疾病（HDP）和妊娠期糖尿病（GDM），与长期 CV 风险增加有关。这项回顾性队列研究在美国东南部的一个大型学术医疗系统中定义了 2012 年至 2015 年间 HDP 和 GDM 的患病率，并描述了在妊娠相关 CV 疾病患者中分娩后 1 年内的医疗保健利用情况和常规 CV 筛查。根据提供者类型和妊娠相关 CV 疾病，比较了产后第一年随访就诊次数和血压、糖化血红蛋白（HbA1c）和血脂筛查率。在纳入的 6027 例分娩中，20%并发 HDP 和/或 GDM。妊娠前 CV 危险因素的发生率较高，HDP 孕妇的孕前肥胖比例明显高于正常妊娠。同时患有 HDP/GDM 的患者在产后 1 年内的随访率最高，但只有一半的妊娠相关 CV 疾病患者在 12 周后有任何随访。尽管大多数（70%）HDP 患者有产后血压筛查，但不到三分之一的 GDM 患者在 12 个月时有重复的 HbA1c。总体而言，产后血脂筛查很少见（<20%）。在美国一个大型学术医疗系统中，妊娠相关 CV 疾病负担很高。尽管产后早期随访总体率较高，但存在纵向随访的差距。1 年时 CV 危险因素随访率低表明早期 CV 预防的机会丧失。
