Primary Care Cardiovascular Risk Reduction after Pregnancy Complications: A Qualitative Systematic Review

Background Adverse pregnancy outcomes (APOs) affect approximately 30% of pregnancies and confer lifelong elevated cardiovascular disease (CVD) risk. Behavioural interventions may mitigate this risk. Aim To systematically review qualitative literature on women's experiences of behavioural change for cardiovascular risk reduction following APOs, with a focus on health equity. Design and setting Qualitative systematic review. Limited to high income countries with universal access to healthcare. Method A systematic search of PubMed, Embase, CINAHL from inception to March 2025 identified primary studies. Thematic synthesis followed Thomas and Harden's three-stage approach. Themes were mapped onto the COM-B framework to theoretically ground and structure analysis. Results Eighteen studies involving 339 women met inclusion criteria. Minority ethnic women formed the majority in only two studies. Demographic data regarding socio-economic status, ethnicity or both were absent from five. Experiences shaping behaviour change aligned with COM-B domains. Delayed physical and psychological recovery after APOs reduced women's capability to initiate changes. Competing demands, including childcare, household responsibilities and work, restricted opportunity to focus on long‑term cardiovascular health. Opportunities improved when behaviour changes were easily integrated into family life and offered shared benefits. Motivation was strengthened by awareness of increased CVD risk, the responsibilities of parenthood, and personalised advice from healthcare professionals. Tailored, proactive follow‑up supported engagement, especially for minority ethnic and socio‑economically disadvantaged groups. Conclusion Prevention of CVD after APOs requires structured, system‑level support to prioritise family-based behaviour change. High-risk groups are under‑represented in research; coproducing interventions with these groups may help to avoid widening health inequalities.