Pregnancy-related cardiovascular risk indicators: Primary care approach to postpartum management and prevention of future disease.

OBJECTIVE: To define pregnancy-related cardiovascular risk indicators and their association with developing future cardiovascular disease (CVD), and to provide guidance on how primary care providers can help lower future CVD risk through early identification and intervention. SOURCES OF INFORMATION: Primary research sources, systematic reviews and meta-analyses, and clinical review articles. MAIN MESSAGE: Cardiovascular disease is the leading cause of death in women. As underlying CVD risk factors are often present for years before the onset of CVD, it is important to use innovative ways to identify women who should undergo CVD risk screening at a younger age. Pregnancy and the postpartum period afford that opportunity, given that the development of certain pregnancy complications (hypertensive disorders of pregnancy, gestational diabetes mellitus, idiopathic preterm birth, delivery of a baby with intrauterine growth restriction, or placental abruption) can reliably identify women with underlying, often unrecognized, CVD risk factors. CONCLUSION: Women with 1 or more of these pregnancy complications should be identified at the time of delivery and have formalized postpartum follow-up, including a thorough history, a physical examination, biochemical screening, counseling around lifestyle modification, and possible therapeutic intervention. The link between pregnancy complications and future CVD affords the earliest opportunity for CVD risk assessment for health preservation and disease prevention.