Obstetrical Complications and Long-Term Cardiovascular Outcomes.

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.