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Review
Management of cardiovascular risk factors during pregnancy
  1. Rebecca H Lumsden1,
  2. Neha Pagidipati1,2
  1. 1 Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
  2. 2 Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Rebecca H Lumsden, Department of Medicine (General Internal Medicine), Duke University School of Medicine, Durham, NC 27710, USA; rebecca.lumsden{at}duke.edu

Abstract

Cardiovascular (CV) risk factors are rising among women of reproductive age. Obesity, hyperlipidaemia, diabetes, and hypertension are associated with adverse pregnancy outcomes and increased CV disease (CVD) risk following pregnancy. Pre-conception counselling and longitudinal postpartum follow-up with ongoing CV risk factor screening are critical for early CVD prevention, though significant racial/ethnic disparities in access to care result in significant gaps. This review summarises the recommended management of CV risk factors during and after pregnancy. For obesity, prevention of excessive weight gain is critical. Except in rare cases, lipid-lowering therapies for women with hyperlipidaemia should be stopped before pregnancy. Women with diabetes in pregnancy should maintain tight glucose control, with hemolgobin A1c (HbA1c) <6.5% to prevent congenital abnormalities. Hypertensive disorders of pregnancy are associated with high maternal and neonatal morbidity and require long-term follow-up to prevent future CVD. Finally, this review highlights the lack of clinical trials informing optimal treatment strategies of CV risk factors during and after pregnancy. Further research is needed to better understand how to improve long-term CV health among this high-risk population.

  • pregnancy
  • epidemiology
  • hyperlipidaemias
  • hypertension
  • metabolic syndrome

https://doi.org/10.1136/heartjnl-2021-319606

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    Footnotes

    • Contributors Both coauthors have approved the submission of this version of the manuscript and have had full access to all aspects of the research and writing process. RHL and NP both contributed to the design of the article. RHL drafted the written manuscript. Both authors contributed equally to the editing and revision process.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests NP reports research grants from: Amgen, AstraZeneca, Baseline Study, Boehringer Ingelheim, Duke Clinical Research Institute, Eggland’s Best, Eli Lilly & Company, Novartis Pharmaceuticals, Novo Nordisk Pharmaceutical Company, Sanofi and Verily Sciences Research Company. She reports consulting fees from AstraZeneca, Boehringer Ingelheim, Esperion Therapeutics, Eli Lilly & Company and Novo Nordisk Pharmaceutical Company. Please see attached ICMJE form.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Commissioned; externally peer reviewed.