Trends in Cardiovascular Health Counseling Among Postpartum Individuals

• Published in: JAMA : the journal of the American Medical Association Vol. 330; no. 4; pp. 359 - 367
• Main Authors: Cameron, Natalie A, Yee, Lynn M, Dolan, Brigid M, O’Brien, Matthew J, Greenland, Philip, Khan, Sadiya S
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 25.07.2023
• Subjects: Adult; Cardiovascular diseases; Cardiovascular System; Counseling; Counseling - trends; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Female; Health risks; Heart Disease Risk Factors; Heart diseases; Humans; Hypertension; Hypertension - epidemiology; Infant, Newborn; Mathematical analysis; Monitoring systems; Original Investigation; Parturition; Postpartum; Postpartum Period; Pregnancy; Pregnancy complications; Pregnancy Complications - epidemiology; Pregnancy Complications, Cardiovascular - epidemiology; Pregnancy Complications, Cardiovascular - therapy; Pregnancy Outcome - epidemiology; Premature birth; Premature Birth - epidemiology; Prevalence; Risk; Risk assessment; Risk factors; Self report; Trends; United States - epidemiology; United States
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2023.11210

IMPORTANCE: Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals. OBJECTIVE: To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit. DESIGN, SETTING, AND PARTICIPANTS: Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]). EXPOSURES: Total number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs). MAIN OUTCOMES AND MEASURES: Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year. RESULTS: From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, −1.4% [95% CI, −1.8% to −1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, −0.7% [95% CI, −1.3% to −0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, −0.8% [95% CI, −1.3% to −0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors. CONCLUSIONS AND RELEVANCE: Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.