Obstetrical Complications and Long-Term Cardiovascular Outcomes
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PREECLAMPSIA (VD GAROVIC, SECTION EDITOR)
Obstetrical Complications and Long-Term Cardiovascular Outcomes Megan Savage 1 & Diala Steitieh 2 & Nivee Amin 3 & Line Malha 4 & Stephen Chasen 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Obstetrical complications including indicated preterm birth (PTB), hypertension (HTN), IUGR, and GDM are risk factors for future cardiovascular disease. To identify patients at risk, the American Heart Association recommends obtaining a detailed obstetric history. Our objective was to determine if non-OB-GYN physicians-in-training obtain an obstetric history when assessing a risk profile for cardiovascular disease and to identify differences based on level of training. In 2019, an anonymous survey was distributed to trainees in internal medicine, cardiology, endocrinology, nephrology, and neurology. Subjects were queried about frequency of asking a history of PTB, IUGR, GDM, and HTN in pregnancy. Survey options were always/frequently/sometimes/rarely/never and were categorized into two groups: “ask” (always/frequently/sometimes) vs. “do not ask” (rarely/never). Comparisons between specialties and levels of training were made using chi-square and Fisher’s exact test. Comparisons within subjects were made using McNemar’s test. Recent Findings The response rate was 64% (210 total possible participants), including 98 internal medicine residents and 37 fellows in cardiology (21), endocrinology (3), nephrology (8), and neurology (5). Asking about medical complications (HTN + GDM) was significantly more common than asking about OB complications (PTB + IUGR) (p < 0.001). Internal medicine residents were less likely than subspecialty fellows to ask about HTN (31% vs. 70%; p < 0.001). There were no differences in likelihood of eliciting OB history based on PGY level. Summary An OB history can identify risk factors for cardiovascular morbidity. Our data demonstrates that physicians caring for women lack awareness on the association between complications in pregnancy and cardiovascular health. Keywords Pregnancy . Medical education . Cardiovascular health
Introduction Obstetrical complications are associated with future cardiovascular health risks for women. For example, preterm birth This article is part of the Topical Collection on Preeclampsia * Megan Savage [email protected] 1
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Weill Cornell Medicine, 525 East 68th Street Box 122, New York, NY 10065, USA
2
Department of Medicine, Weill Cornell Medicine, New York, NY, USA
3
Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
4
Division of Nephrology & HTN, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
(PTB) is associated with a two-fold increase of future cardiovascular disease, and the highest risk is associated with delivery < 32 weeks gestation or an indicated preterm delivery. A history of recurrent preeclampsia or fetal growth restriction (IUGR) is
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