Prevention of Cardiovascular Disease in Women With Pregnancy‐Related Risk Factors: A Prospective Women's Heart Clinic Study

Abstract

Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small‐for‐gestational‐age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy‐related conditions is lacking. Methods and Results A 6‐month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small‐for‐gestational age baby in Melbourne, Australia. The co‐primary end points were (1) blood pressure <140/90 mm Hg or <130/80 mm Hg if diabetes and (2) total cholesterol to high‐density lipoprotein cholesterol ratio <4.5. The study recruited 156 women with a mean age of 41.0±4.2 years, 3.9±2.9 years from last delivery, 68.6% White, 20.5% South/East Asian, and 80.5% university‐educated. The proportion meeting blood pressure target increased (69.2% to 80.5%, P =0.004), with no significant change in lipid targets (80.6% to 83.7%, P =0.182). Systolic blood pressure (−6.9 mm Hg [95% CI, −9.1 to −4.7], P <0.001), body mass index (−0.6 kg/m 2 [95% CI, −0.8 to −0.3], P <0.001), low‐density lipoprotein cholesterol (−4.2 mg/dL [95% CI, −8.2 to −0.2], P =0.042), and total cholesterol (−4.6 mg/dL [95% CI, −9.1 to −0.2] P =0.042) reduced. Heart‐healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, P =0.012), decreased fast food consumption (33.8% to 11.0%, P <0.001), and increased physical activity (84.0% to 92.9%, P =0.025). Conclusions Women at high risk for cardiovascular disease due to past pregnancy‐related conditions experienced significant improvements in multiple cardiovascular risk factors after attending a Women's Heart Clinic, potentially improving long‐term cardiovascular disease outcomes. Registration URL: https://www.anzctr.org.au ; Unique identifier: ACTRN12622000646741.