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Obstetrical Complications and Long-Term Cardiovascular Outcomes
Megan Savage1, Diala Steitieh2, Nivee Amin3
1Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Weill Cornell Medicine, 525 East 68th Street Box 122, New York, NY, 10065, USA. mes9168@nyp.org.
Insights
Physicians-in-training rarely ask about obstetric history, missing key cardiovascular disease risk factors like preterm birth and gestational diabetes. This highlights a critical gap in cardiovascular risk assessment for women.
Area of Science:
- Cardiology
- Obstetrics and Gynecology
- Preventive Medicine
Background:
- Obstetric complications such as preterm birth (PTB), hypertension (HTN), intrauterine growth restriction (IUGR), and gestational diabetes mellitus (GDM) are established risk factors for future cardiovascular disease (CVD).
- The American Heart Association recommends a detailed obstetric history for identifying at-risk patients.
- Physician awareness of the link between pregnancy complications and long-term cardiovascular health is crucial for effective risk stratification.
Purpose of the Study:
- To assess whether non-OB-GYN physicians-in-training inquire about obstetric history when evaluating cardiovascular disease risk.
- To identify variations in the practice of obtaining obstetric history based on the physician's specialty and level of training.
Main Methods:
- An anonymous survey was administered in 2019 to internal medicine residents and subspecialty fellows (cardiology, endocrinology, nephrology, neurology).
- Participants reported the frequency of asking about PTB, IUGR, GDM, and HTN during pregnancy using a five-point scale, categorized as 'ask' or 'do not ask'.
- Statistical analyses, including chi-square and Fisher's exact tests, were used to compare frequencies between specialties and training levels.
Main Results:
- A total of 210 trainees responded (64% response rate), with 98 internal medicine residents and 37 fellows.
- Physicians were significantly more likely to inquire about medical complications (HTN + GDM) than obstetric complications (PTB + IUGR) (p < 0.001).
- Internal medicine residents were less likely to ask about HTN compared to subspecialty fellows (31% vs. 70%; p < 0.001), with no significant differences based on postgraduate year (PGY) level.
Conclusions:
- Physicians caring for women demonstrate a lack of awareness regarding the association between pregnancy complications and cardiovascular health.
- The findings underscore a gap in clinical practice concerning the routine collection of obstetric history for cardiovascular risk assessment.
- Educational interventions may be necessary to improve physicians' understanding and application of obstetric history in CVD risk profiling.
Purpose Of Review:
Obstetrical complications including indicated preterm birth (PTB), hypertension (HTN), IUGR, and GDM are risk factors for future cardiovascular disease. To identify patients at risk, the American Heart Association recommends obtaining a detailed obstetric history. Our objective was to determine if non-OB-GYN physicians-in-training obtain an obstetric history when assessing a risk profile for cardiovascular disease and to identify differences based on level of training. In 2019, an anonymous survey was distributed to trainees in internal medicine, cardiology, endocrinology, nephrology, and neurology. Subjects were queried about frequency of asking a history of PTB, IUGR, GDM, and HTN in pregnancy. Survey options were always/frequently/sometimes/rarely/never and were categorized into two groups: "ask" (always/frequently/sometimes) vs. "do not ask" (rarely/never). Comparisons between specialties and levels of training were made using chi-square and Fisher's exact test. Comparisons within subjects were made using McNemar's test.
Recent Findings:
The response rate was 64% (210 total possible participants), including 98 internal medicine residents and 37 fellows in cardiology (21), endocrinology (3), nephrology (8), and neurology (5). Asking about medical complications (HTN + GDM) was significantly more common than asking about OB complications (PTB + IUGR) (p < 0.001). Internal medicine residents were less likely than subspecialty fellows to ask about HTN (31% vs. 70%; p < 0.001). There were no differences in likelihood of eliciting OB history based on PGY level. An OB history can identify risk factors for cardiovascular morbidity. Our data demonstrates that physicians caring for women lack awareness on the association between complications in pregnancy and cardiovascular health.
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