1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

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Pregnancy is sometimes complicated by hypertension, preeclampsia, eclampsia, diabetes, and preterm birth. Women who successfully survive pregnancy, labor, birth, and postpartum after experiencing one of these serious conditions are likely relieved; however, emerging evidence suggests these complications of pregnancy are associated with adverse cardiovascular health in later years (American College of Obstetricians and Gynecologists, 2018; Stuart et al., 2018; Tanz et al., 2017). Therefore, during the postpartum visit, women who had any of these complications should be advised of their risk and offered suggestions for risk modification, and frequent follow-up well women visits to assess for development of signs of cardiovascular disease (CVD). It is important that well woman visits include screening for CVD and associated risk factors such as diabetes, hyperlipidemia, hypertension, weight status, and level of routine physical activity (Brown et al., 2018). Women should be referred as needed to cardiologists and other specialists (Brown et al.).


The Nurses' Health Study II has allowed analyses of large groups of women over time with a population that is likely to provide accurate study data and remain in the study for many years (e.g., nurses). Likely, many MCN readers are study participants as am I. The Nurses' Health Study II researchers found that women with hypertensive disorders of pregnancy were more likely to develop CVD later in life (Stuart et al., 2018). They studied 58,571 parous women who did not have CVD or risk factors at baseline, other than those who experienced hypertension during pregnancy. The women were followed over 25 to 32 years. Compared with women who did not have a hypertensive disorder during pregnancy, significantly more women who had this complication reported CVD including chronic hypertension, type 2 diabetes, and hypercholesterolemia (Stuart et al.).


Hypertensive disorders of pregnancy are not the only predictors of future cardiovascular health. Based on 70,182 parous women in the Nurses' Health Study II population, Tanz et al. (2017) found that women who gave birth before 37 weeks gestation were at significantly increased risk of CVD, including myocardial infarction and stroke. Risk was increased more among women who gave birth before 32 weeks. These risks persisted even among women who had not had hypertensive disorders of pregnancy in their first pregnancy. Many of the women later developed chronic hypertension, hypercholesterolemia, type 2 diabetes, and a higher body mass index (Tanz et al.). Giving birth preterm was shown to be a predictor of later CVD.


Cardiovascular health in women is a major concern as CVD is the leading cause of death among women in the United States (Brown et al., 2018). Decades ago, CVD was considered a disease of men; however, we now know that women are often misdiagnosed due to atypical or gender-specific symptoms and that women are more likely to die from a cardiac event compared with men (Appelman, van Rijn, Ten Haaf, Boersma, & Peters, 2015).


Nurses can be especially helpful in providing screening for CVD and education about risk factor modification during the first postpartum visit and during subsequent well woman visits. These types of primary care services can save lives.




American College of Obstetricians and Gynecologists. (2018). Optimizing postpartum care (Committee Opinion No. 736). Obstetrics and Gynecology, 131(5), e140-e150. doi:10.1097/AOG.0000000000002633 [Context Link]


Appelman Y., van Rijn B. B., Ten Haaf M. E., Boersma E., Peters S. A. (2015). Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis, 241(1), 211-218. doi:10.1016/j.atherosclerosis.2015.01.027 [Context Link]


Brown H. L., Warner J. J., Gianos E., Gulati M., Hill A. J., Hollier L. M., ..., Wenger N. K.on behalf of the American Heart Association and the American College of Obstetricians and Gynecologists. (2018). Promoting risk identification and reduction of cardiovascular disease in women through collaboration with obstetricians and gynecologists: A Presidential Advisory From the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation, 137(24), e843-e852. doi:10.1161/CIR.0000000000000582 [Context Link]


Stuart J. J., Tanz L. J., Missmer S. A., Rimm E. B., Spiegelman D., James-Todd T. M., Rich-Edwards J. W. (2018). Hypertensive disorders of pregnancy and maternal cardiovascular disease risk factor development: An observational cohort study. Annals of Internal Medicine. doi:10.7326/M17-2740 [Context Link]


Tanz L. J., Stuart J. J., Williams P. L., Rimm E. B., Missmer S. A., Rexrode K. M., ..., Rich-Edwards J. W. (2017). Preterm delivery and maternal cardiovascular disease in young and middle-aged adult women. Circulation, 135(6), 578-589. doi:10.1161/CIRCULATIONAHA.116.025954 [Context Link]