SE
M I N A R S I N
P
E R I N A T O L O G Y
39 (2015) 253
Available online at www.sciencedirect.com
www.elsevier.com/locate/semperi
Introduction Cardiovascular disease is the leading cause of death for women in the United States, causing approximately 1 death per minute among American women in 2007. After a campaign to educate women about cardiovascular disease (CVD) risks, we have made significant progress in decreasing mortality. However, the rates of CVD are increasing in women aged 35–44 years. In 2011, the AHA published an updated report, “Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women,” which included recommendations to include the obstetric history in a woman's risk assessment. Adverse pregnancy outcomes (APO) include preeclampsia, gestational diabetes, abruption, stillbirth, growth restriction, and preterm birth. These pregnancy complications are consistently associated with a 2–3-fold increased risk of early onset cardiovascular morbidity and mortality among affected women. This finding indicates a need for emphasis on younger women for primary prevention. However, in order to complete this goal, a number of issues must be addressed. They include identification of the at risk individual, implementation of effective interventions for primary and secondary prevention, and coordination of care after delivery. Under the current care structure, women receive pregnancy care, and adverse outcomes are not communicated to the primary care provider. We propose a different model of care where we take into account current and future cardiovascular disease risk. This allows a longer period of time in which patients can be educated and interventions planned with the goal of changing the trajectory of CVD risk.
In February 2014, the Society for Maternal-Fetal Medicine (SMFM), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the American College of Obstetricians and Gynecologists (ACOG) convened a joint Workshop to address these and related issues regarding care and counseling to women who are at risk for these outcomes. Experts in obstetrics, cardiology, internal medicine, and epidemiology reviewed the available literature to have informed discussion and to develop a uniform approach to these women. Further input was provided by other invited experts and registered participants through 3 break-out sessions and follow-up discussions. From these discussions, a summary opinion of experts was developed. This summary document will provide preliminary guidance for care, counseling, education, and research in the topic of “Pregnancy as a Window to Future Health.” This issue of Seminars in Perinatology is devoted to the research and clinical opinions reviewed and presented by our expert panelists and discussed during the Workshop. We hope that the readers will appreciate the strengths and limitations of the existing data. However, the information provided in this issue will serve as guidance in clinical practice, educational efforts, and guide future research.
Judette Louis, MD and George Saade, MD http://dx.doi.org/10.1053/j.semperi.2015.05.001 0146-0005/& 2015 Elsevier Inc. All rights reserved.
M I N A R S I N
P
E R I N A T O L O G Y
39 (2015) 253
Available online at www.sciencedirect.com
www.elsevier.com/locate/semperi
Introduction Cardiovascular disease is the leading cause of death for women in the United States, causing approximately 1 death per minute among American women in 2007. After a campaign to educate women about cardiovascular disease (CVD) risks, we have made significant progress in decreasing mortality. However, the rates of CVD are increasing in women aged 35–44 years. In 2011, the AHA published an updated report, “Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women,” which included recommendations to include the obstetric history in a woman's risk assessment. Adverse pregnancy outcomes (APO) include preeclampsia, gestational diabetes, abruption, stillbirth, growth restriction, and preterm birth. These pregnancy complications are consistently associated with a 2–3-fold increased risk of early onset cardiovascular morbidity and mortality among affected women. This finding indicates a need for emphasis on younger women for primary prevention. However, in order to complete this goal, a number of issues must be addressed. They include identification of the at risk individual, implementation of effective interventions for primary and secondary prevention, and coordination of care after delivery. Under the current care structure, women receive pregnancy care, and adverse outcomes are not communicated to the primary care provider. We propose a different model of care where we take into account current and future cardiovascular disease risk. This allows a longer period of time in which patients can be educated and interventions planned with the goal of changing the trajectory of CVD risk.
In February 2014, the Society for Maternal-Fetal Medicine (SMFM), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the American College of Obstetricians and Gynecologists (ACOG) convened a joint Workshop to address these and related issues regarding care and counseling to women who are at risk for these outcomes. Experts in obstetrics, cardiology, internal medicine, and epidemiology reviewed the available literature to have informed discussion and to develop a uniform approach to these women. Further input was provided by other invited experts and registered participants through 3 break-out sessions and follow-up discussions. From these discussions, a summary opinion of experts was developed. This summary document will provide preliminary guidance for care, counseling, education, and research in the topic of “Pregnancy as a Window to Future Health.” This issue of Seminars in Perinatology is devoted to the research and clinical opinions reviewed and presented by our expert panelists and discussed during the Workshop. We hope that the readers will appreciate the strengths and limitations of the existing data. However, the information provided in this issue will serve as guidance in clinical practice, educational efforts, and guide future research.
Judette Louis, MD and George Saade, MD http://dx.doi.org/10.1053/j.semperi.2015.05.001 0146-0005/& 2015 Elsevier Inc. All rights reserved.
