The Hidden Cardiovascular Threat Post-Pregnancy: A Call for Comprehensive Care

Dr. Janice Krystal Ascencio holds the position of Acting Chairperson of the Obstetrics and Gynecology department and serves as the Director of the OB/GYN ambulatory Clinics at Jamaica Hospital Medical Center. With over two decades of dedicated practice, Dr. Ascencio is recognized for her profound dedication to women's health and empowerment. She specializes in minimally invasive gynecological procedures while providing comprehensive obstetrical care. Her passion for educating women about their bodies and promoting health literacy underscores her commitment to elevating women's well-being.

Through this article, Dr. Janice Krystal Ascencio addresses the often-overlooked link between pregnancy complications and long-term cardiovascular risks for women. She emphasizes the importance of comprehensive postpartum care and advocates for increased awareness among healthcare providers and patients alike. Dr. Ascencio discusses the need for standardized follow-up protocols, regular cardiovascular screenings, and innovative care models like group visits to empower women to manage their health beyond pregnancy.

In the landscape of women’s health, pregnancy is often seen as a temporary journey with a clear endpoint: the birth of a child. However, for many women, the implications of pregnancy extend far beyond the delivery room. Complications such as chronic hypertension, gestational hypertension, preeclampsia, diabetes, preterm birth and stillbirth are not just temporary hurdles; they are harbingers of long-term cardiovascular risks. The lack of awareness among both physicians and patients exacerbates this problem, leaving many women vulnerable to cardiovascular disease (CVD) later in life.

Pregnancy complications like preeclampsia and gestational hypertension have been shown to significantly increase the risk of developing CVD. Women with a history of preeclampsia, for instance, are at double the risk of stroke and four times the risk of hypertension compared to those with uncomplicated pregnancies. Similarly, gestational diabetes not only increases the risk of type 2 diabetes but also raises the likelihood of cardiovascular issues. These statistics are further compounded in women who are black and brown, with disparities based on racism and socioeconomic status. Despite these stark statistics, the connection between these pregnancy complications and long-term cardiovascular health is often overlooked in postpartum care.  This may be due to patient's lack of awareness of the importance of their postpartum care or lapses in their insurance coverage.

The gap in awareness is twofold: physicians and mid-level providers may not be fully informed about the extended risks, and patients are seldom educated on the potential for future health issues. This lack of knowledge and dialogue means missed opportunities for early intervention and preventive care. To address this, a comprehensive approach to postpartum care is essential, one that not only treats the immediate aftermath of pregnancy but also looks forward to safeguarding future health.

Firstly, educating both healthcare providers and patients about the risks is crucial. Medical professionals—a multidisciplinary team including obstetrician/gynecologist, emergency department, cardiology and primary care, need robust training programs that emphasize the long-term cardiovascular risks associated with pregnancy complications. This training should be integrated into medical school curriculums, residency programs and continuing education courses. By equipping providers with this knowledge, they can better counsel and manage the care of their patients.

Secondly, creating systems for consistent diagnostic testing and follow-up care is vital. Women who have experienced high-risk pregnancies should undergo regular cardiovascular screenings, including echocardiogram, blood pressure monitoring, lipid profiles and glucose tolerance tests. Establishing standardized protocols for such follow-ups can help detect and manage potential problems early.

Moreover, innovative care models such as group visits could revolutionize postpartum care for these high-risk women. Group visits can provide a platform for education, peer support and shared experiences, fostering a sense of camaraderie among women who have faced similar challenges. These sessions can be led by a multidisciplinary team, including cardiologists, obstetricians, endocrinologists, dietitians and social service providers, offering a holistic approach to managing their health.

Group visits also present an opportunity for continuous education on lifestyle changes and management strategies that can mitigate cardiovascular risks. Topics could include nutrition, physical activity, stress management and medication adherence, tailored to the unique needs of women with histories of pregnancy complications. Such a program is being built here at Jamaica Hospital in Queens, New York.  We are in the process of building this group visit model based on our experience with CenteringPregnancy.  We have created a cardiac risk survey to check the level of awareness in our community.  Armed with this data, our next step is to collaborate with our colleagues in cardiology to start groups with a maximum participation of 10 individuals. As described above, in addition to lifestyle education, participants would undergo annual comprehensive health assessments, including echocardiograms (EKG), cardiac echocardiography, metabolic profiles and lipid profiles. These tests are crucial for monitoring heart health and stratifying cardiovascular risk, allowing for timely and targeted interventions.

In conclusion, the link between pregnancy complications and long-term cardiovascular risk is a critical issue that demands immediate attention. By enhancing awareness, training healthcare providers, implementing standardized follow-up protocols and fostering supportive group care models, we can significantly improve the cardiovascular health outcomes for these women. This comprehensive approach is not just about preventing disease but about empowering women to take charge of their health, ensuring they receive the care and attention they deserve long after their pregnancies have ended. The journey of pregnancy may conclude with birth, but the journey of health continues and it is our collective responsibility to support women every step of the way.