Featuring: Sadiya Khan, ’09 MD, ’14 MSc, ’10, ’12 GME
‘We are missing women with risk factors who are already on a fast track to heart disease’
Despite having risk factors for heart disease, only 60 percent of women reported receiving counseling on optimizing their heart health, which includes healthy eating, exercise and losing weight gained during pregnancy at their six-week postpartum visit between 2016 and 2020, a new Northwestern Medicine study published in JAMA has found.
About 90 percent of women in the U.S. attend at least one postpartum visit during what is commonly referred to as the “fourth trimester.” For these women, who are already juggling other demands — such as adjusting to life with a new child and returning to work — this visit is considered one of the few times during the first year after pregnancy to prioritize their own health, the study authors said.
“We need to find ways to take advantage of this prime opportunity when we have a captive audience of people who are already in the doctor’s office, talking about their health at a critical juncture in life,” said corresponding author Sadiya Khan, ’09 MD, ’14 MSc, ’10, ’12 GME, the Magerstadt Professor of Cardiovascular Epidemiology and a Northwestern Medicine physician. “It is hard to create new opportunities. The fourth-trimester visit is an already-ready moment to prioritize maternal heart health.”
The study is the first to describe contemporary rates of heart-health counseling during postpartum visits for women with heart disease risk factors or who experienced pregnancy complications. It found between 2016 and 2020, the frequency of heart disease risk factors — being overweight, having diabetes or high blood pressure and delivering preterm — increased among birthing adults.
“Our data shows 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 long-term risk of heart disease,” said lead author Natalie Cameron, MD, ’21 GME, instructor of Medicine in the Division of General Internal Medicine 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. “Healthcare 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.”
Remembering their counseling is key
It is important to note that more women may have received counseling but only 60 percent of women reported remembering that they received counseling on how to optimize their heart health, said Khan, who is also an assistant professor of Medicine in the Division of Cardiology and of Preventive Medicine in the Division of Epidemiology.
“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?
From a structural level, systems and policies must support these healthcare transitions from pregnancy to postpartum and ensure women can access care throughout the first-year postpartum and beyond. Continuing to expand postpartum Medicaid coverage from 60 days to 12-months postpartum is a critical first step to improving access to care for the more than 40 percent of U.S. women who are insured by Medicaid during pregnancy, Cameron said.
“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.
The study is titled, “Trends in cardiovascular health counseling among postpartum individuals.” Other Northwestern co-authors include Lynn Yee, ’08 MD, ’08 MPH, the Thomas J. Watkins Memorial Professor of Obstetrics and Gynecology; Brigid Dolan, MD, MEd, associate professor of Medicine in the Division of General Internal Medicine and of Medical Education; Matthew O’Brien, MD, associate professor of Medicine in the Division of General Internal Medicine and of Preventive Medicine in the Division of Epidemiology; and Philip Greenland, MD, the Harry W. Dingman Professor of Cardiology.
Funding for the study was provided by the National Heart, Lung and Blood Institute of the National Institutes of Health grant R01HL161514-02.
This article was originally published in the Feinberg School of Medicine News Center on July 25, 2023.
Sadiya Khan, ’09 MD, ’14 MSc, ’10, ’12 GME, the Magerstadt Professor of Cardiovascular Epidemiology and a Northwestern Medicine physician, was corresponding author of the study published in JAMA.
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