Reducing a Woman’s Long-Term Risk of Heart Disease Requires Postpartum Counseling

At their six-week postpartum visit between 2016 and 2020, only 60% of women reported receiving counseling on improving their heart health, which includes healthy eating, exercise, and losing weight gained during pregnancy, despite having risk factors for heart disease, according to a new Northwestern Medicine study.

At least one postpartum visit is attended by 90% of American women during the period known as the “fourth trimester.” This visit is one of the few opportunities for these women, who are already balancing other obligations like adjusting to life with a new baby and going back to work, within the first year after giving birth to prioritize their own health, according to the study’s authors.

The study is the first to describe current rates of heart health counseling for women with heart disease risk factors or who had pregnancy problems during postpartum visits. It was discovered that among giving birth to adults between 2016 and 2020, the prevalence of heart disease risk factors such as being overweight, having diabetes or high blood pressure, and giving birth prematurely increased.

“Our data show that reports of overall counseling are low. For people who have risk factors, lifestyle counseling during this critical time is a first step to reducing the long-term risk of heart disease,” said lead author Dr. Natalie Cameron, instructor of general internal medicine at Feinberg and a Northwestern Medicine physician.

“While the postpartum visit represents an opportunity to reach a large number of women, it is only the start,” Cameron said. “Health care systems must improve continuity of care after pregnancy and help women find clinicians who can provide preventive care. These can be obstetricians/gynecologists, primary care clinicians, or cardiologists, depending on the patient’s needs and the clinician’s expertise.”

It’s important to recall their counseling

Although more women may have sought counseling, just 60% of women stated they could recall receiving advice on how to improve their cardiovascular health, according to Khan.

“I think it’s important that we also prioritize implementation science research that identifies the best strategies for counseling to improve heart health, particularly in the first year after pregnancy,” Khan said. “If counseling is provided but they don’t remember it or it does not translate into improvements in heart health, it’s not very effective.”

What can be done?

Systems and policies must support these structural changes in health care from pregnancy to postpartum and guarantee that women have access to care for the first year after delivery and beyond. For the more than 40% of American women who get Medicaid coverage throughout pregnancy, Cameron noted that continuing to extend postpartum Medicaid coverage from 60 days to 12 months after delivery is a crucial first step in enhancing access to care.

“In the midst of the growing public health crisis around maternal health, we also need to continue to increase awareness of the importance of long-term cardiovascular health monitoring and optimization among women with adverse pregnancy outcomes,” she said.