Variations in Awareness of Association Between Adverse Pregnancy Outcomes and Cardiovascular Risk by Specialty

Venkata Sai M Gogineni; Denise Manfrini; Sharon H Aroda; Yahan Zhang; Danielle S Nelson; Robert Egerman; Ki Park

doi:10.1007/s40119-021-00220-y

Variations in Awareness of Association Between Adverse Pregnancy Outcomes and Cardiovascular Risk by Specialty

Cardiol Ther. 2021 Dec;10(2):577-592. doi: 10.1007/s40119-021-00220-y. Epub 2021 May 27.

Authors

Venkata Sai M Gogineni¹, Denise Manfrini², Sharon H Aroda¹, Yahan Zhang³, Danielle S Nelson⁴, Robert Egerman⁵, Ki Park⁶

Affiliations

¹ Department of Internal Medicine, University of Florida, Gainesville, FL, USA.
² University of Florida College of Medicine, Gainesville, FL, USA.
³ Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
⁴ Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.
⁵ Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA.
⁶ Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA. ki.park@medicine.ufl.edu.

Abstract

Introduction: Cardiovascular disease (CVD) remains the leading cause of death among women. Adverse pregnancy outcomes (APOs), including pre-eclampsia (PE), gestational diabetes mellitus (GDM) and pre-term birth (PTB) are associated with future maternal CVD risk. However, data on awareness of the association between APOs and long-term CVD risk among physicians in different specialties are lacking. This study assessed awareness of this association and whether this knowledge varies by specialty.

Methods: An anonymous web-based voluntary survey was sent to physicians in internal medicine (IM), family medicine (FM), obstetrics-gynecology (Ob-Gyn) and cardiology. The questions aimed to assess a physician's knowledge regarding identification of APOs and their association with future CVD risk and knowledge of CVD risk factor screening in women with APOs and future CVD risk.

Results: The survey was completed by 53 physicians, of whom 21% were in IM, 26% in FM, 23% in Ob-Gyn and 30% in cardiology. Based on the responses, cardiologists screened most frequently for APOs, with 56% always screening a female patient and 31% often screening. Only half of the IM and FM physicians acknowledged awareness of the association between APOs and CVD risk. Respondents in all specialties recognized PE and GDM as APOs linked to long-term maternal CVD risk, but failed to associate PTB as an APO. The majority of physicians in IM, FM and cardiology also lacked the knowledge of how often to appropriately screen for CVD risk factors associated with APOs.

Conclusion: Awareness of the association between APO and future maternal CVD risk varies by specialty. A significant percentage of the physicians who responded to the survey did not routinely ask about APOs when assessing CVD risk and failed to identify PTB as a risk factor for APOs. Education on this topic and targeted efforts to improve screening for APOs are needed within all specialties to help reduce CVD morbidity and mortality.

Keywords: Adverse pregnancy outcomes; Cardiovascular disease; Pre-eclampsia; Primary prevention; Risk reduction.