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Pregnancy and the Postpartum Period as an Opportunity for Cardiovascular Risk Identification and Management

Smith, Graeme N. MD, PhD; Louis, Judette Marie MD, MPH; Saade, George R. MD

doi: 10.1097/AOG.0000000000003363
Contents: Medical Complications of Pregnancy: Clinical Expert Series
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Cardiovascular disease (CVD) is the leading cause of death in women. Because women generally present with more atypical symptoms of CVD than do men and because underlying CVD risk factors are often present for years before the onset of CVD, it is important to use innovative ways to identify women who should undergo CVD risk screening at a younger age. Pregnancy and the postpartum period afford us that opportunity, given that the development of certain pregnancy complications (hypertensive disorders of pregnancy, gestational diabetes, preterm birth, delivery of a neonate with fetal growth restriction, and significant placental abruption) can reliably identify women with underlying, often unrecognized, CVD risk factors. Women with one or more of these pregnancy complications should be identified at the time of delivery and referred for regular follow-up. This would ideally take the form of a multidisciplinary clinic including clinicians and allied health specialists to carry out physical and biochemical screening and counseling regarding lifestyle modification and possible therapeutic interventions. Longer-term follow-up and recommendations should be individualized based on findings and risks. There is also an opportunity for future pregnancy counseling and discussion about the importance of weight loss between pregnancies, initiation of a routine involving physical activity, use of preconception folic acid, and the potential initiation of low-dose aspirin for those women at risk for future preeclampsia and fetal growth restriction or the use of progesterone for women at risk for preterm labor. The link between pregnancy complications and future CVD affords us with the earliest opportunity for CVD risk assessment for health preservation and disease prevention.

Pregnancy identifies women who are candidates for postpartum interventions to decrease their risk for future cardiovascular disease.

Departments of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada, the University of South Florida, Tampa, Florida, and the University of Texas Medical Branch at Galveston, Galveston, Texas.

Corresponding author: George R. Saade, MD, Department of Obstetrics & Gynecology, the University of Texas Medical Branch at Galveston, Galveston, TX; email:

Supported by a Canadian Institutes of Health Research Planning Grant [KPE-132276] to Graeme N. Smith.

Financial Disclosure Judette Marie Louis has received research funding from Kyndermed. George R. Saade is a consultant for Gestvision and Sera Diagnostics. The other author did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.