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Published on: January 12, 2018
Addressing cardiovascular risk after adverse pregnancy outcomes: a health equity-focused qualitative review
Victoria Hodges, Caroline Mitchell, Carolyn Chew-Graham
1Keele University, Keele, UK.
Insights
Women experiencing adverse pregnancy outcomes (APOs) face higher cardiovascular disease (CVD) risks. Postnatal lifestyle interventions are desired, but barriers like inadequate postpartum care and self-prioritization guilt hinder progress, especially for high-risk groups.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Cardiology
Background:
- Adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy (HDP), preterm labor, and fetal growth restriction, significantly increase long-term cardiovascular disease (CVD) risk.
- This elevated risk disproportionately affects women from ethnic minorities and socio-economically deprived backgrounds.
- Women with a history of APOs have a doubled risk of CVD, with pre-eclampsia linked to premature mortality from CVD.
Purpose of the Study:
- To review women's perspectives on postnatal lifestyle interventions aimed at mitigating long-term CVD risk.
- Focus on identifying the needs and preferences of highest-risk groups, including ethnic minorities and socio-economically deprived women.
Main Methods:
- Qualitative systematic review and thematic synthesis.
- Analysis of qualitative components from research papers reporting on women's views regarding CVD risk management after APOs.
- Protocol registered on PROSPERO (CRD420250654735).
Main Results:
- Pregnancy can motivate lifestyle changes, but significant barriers exist, including insufficient physical/psychological recovery and guilt over self-care.
- Women reported feeling abandoned post-partum, contrasting the intensive monitoring during pregnancy with inadequate postnatal care.
- A strong desire for structured, formal postnatal follow-up was identified, particularly among high-risk groups who are less likely to seek care independently.
Conclusions:
- Postnatal care for women with APOs is inadequate, leading to unmet needs for lifestyle interventions.
- Structured follow-up and community-based support are crucial for addressing long-term CVD risk in these women.
- Future research and interventions should prioritize co-design with community groups to improve engagement and outcomes.
Background:
Cardiovascular disease (CVD) risk increases following adverse pregnancy outcomes (APOs) including hypertensive disorders of pregnancy (HDP), preterm labour, and foetal growth restriction. APOs disproportionately affect women of certain ethnic minorities and those who are socio-economically deprived. Risk of CVD after APOs is approximately doubled and two-thirds of women experiencing pre-eclampsia die prematurely from CVD.
Aim:
This review examines women's perspectives on postnatal lifestyle interventions to address long-term CVD risk, focusing on highest-risk groups.
Method:
Qualitative systematic review and thematic synthesis. A protocol was registered on PROSPERO (CRD420250654735). Papers were included if they contained qualitative components reporting views on addressing CVD risk in women experiencing APOs.
Results:
Of 1887 screened articles 33% of included papers demonstrated recruitment of an ethnically diverse participant group, 39% demonstrated diversity of socioeconomic status. Themes from the synthesis were 1) pregnancy is a motivator for lifestyle change but many barriers exist, including lack of physical and psychological recovery and guilt at self-prioritisation, and 2) women felt abandoned, seeing a contrast between highly monitored pregnancies and inadequate post-partum care. They desire structured post-partum follow-up with formal recalls, those from higher risk groups are particularly unlikely to seek follow-up independently. We will run a series of community-based workshops with minority ethnic groups in early 2026. Workshops will be co-facilitated by community link workers. Review findings will be presented and future research priorities will be identified. Findings of both the qualitative evidence synthesis and community-based workshops will be presented at conference.
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