4HER-Embedding a Post-Pregnancy Cardiometabolic Health Clinic Into Routine Care

Women who experience gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP) face a significantly elevated risk of developing chronic diseases, including Type 2 diabetes and cardiovascular disease (CVD). The postpartum period of 3-6 months represents a unique opportunity for targeted risk reduction; yet engagement with follow-up care is often low due to systemic and personal barriers.

This study aimed to adapt and implement a dedicated women-focused, cardio-metabolic risk reduction clinic at an Australian tertiary maternity hospital, modelled on the successful Canadian MotHERS program. We also aimed to describe the initial implementation and baseline characteristics of the attending high-risk cohort.

Using a Hybrid Type 2 design to test the clinical effectiveness and evaluate implementation processes, eligible women with GDM or HDP from the Mater Mothers' Hospitals (MMH) were invited for post-pregnancy visits (3 and 9 months) that focused on risk screening and stratification and systematic connection to primary care. We report on their attendance and baseline clinical and lifestyle characteristics.

The clinic achieved a high initial reach, with 126 of 178 eligible women (70.8%) attending. The cohort demonstrated a high-risk profile; mean BMI was 29.4 (6.3) kg/m², mean waist circumference was 99.7 (14.8) cm, and over 50% of the cohort had a 'high' lifetime cardiovascular risk score. Lifestyle and health screen data also revealed significant modifiable risks CONCLUSION: The implementation of the 4HER clinic successfully engaged a substantial proportion of women with medically complicated pregnancies who demonstrate an elevated baseline burden of cardio-metabolic risk.