Abstract 15958: Obstetrical History That Includes Adverse Pregnancy Outcomes (APO) Are Not Incorporated Into the Creation of Cardiovascular Risk Screening in Adults

Abstract

Introduction: Cardiovascular disease (CVD) is a major contributor to maternal morbidity and mortality and is the leading cause of death for women/assigned female at birth (AFAB) people in the US. People who experience metabolic and hypertensive complications in pregnancy are at an increased risk of hypertension and CVD later in life. ACC/AHA have published clinical guidelines, which includes the use of the ASCVD risk estimator, to identify patients that may benefit from treatment with primary prevention. Our objective was to determine how often OBHx was included in the underlying primary literature that was utilized to create the current CVD screening guidelines. Methods: This is a descriptive study of the cited works, including original research and guidelines, used to develop the 2018 guidelines for the use of risk assessment tools for ASCVD and the 2019 primary prevention of CVD guidelines. Original research citations were analyzed for identification of OBHx. Articles that included OBHx were analyzed for identification of Adverse Pregnancy Outcomes (APO), specific risk factors including preeclampsia/gestational hypertension (GHTN), fetal growth restriction (FGR), preterm delivery (PTD), gestational diabetes (GDM) and peripartum cardiomyopathy (PPCM). We further assessed discussion of OBHx within the articles as: cursory (1-2 sentences), moderate (3-5 sentences), or extensive (>5 sentences). Results: Of the 58 articles included, more than half included AFAB/women, 37 (63.8%), although how sex/gender was assigned was not delineated. Of these only 3 (5.2% of total) included OBHx. In 2 of the studies OBHx was identified by maternal recall, while 1 study performed a chart review. Of the 3 studies that included OBHx, 2 (66.6%) included history of preeclampsia/GHTN and PTD. FGR and GDM were each identified in 1 article. None of the articles included PPCM. An extensive discussion of APO risk factors was included for 2, while 1 study had a moderate discussion. Conclusions: Most of the data used to create the primary prevention of CVD guidelines provide very little information regarding OBHx. This may lead to an underestimation of CVD risk in AFAB people and potentially fail to identify those that may benefit from treatment for primary prevention of CVD.