Abstract MP74: Trends in Cardiovascular Health Counseling Among Postpartum Individuals in the United States From 2016-2020: The Pregnancy Risk Assessment Monitoring System

Abstract

Introduction: Poor pre-pregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are risk factors (RF) for lifetime risk of cardiovascular disease. Contemporary rates and trends of CVH counseling can inform strategies to optimize postpartum CVH. Methods: We used data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a national, population-based survey of postpartum individuals. The primary outcome was self-report of counseling received on “healthy eating, exercise, and losing weight gained during pregnancy,” at the 4-6 week postpartum visit. We calculated the age-standardized weighted percent of individuals reporting CVH counseling for each year, overall, and by RF strata: (1) any pre-pregnancy CVH factor (obesity, diabetes, or hypertension) and (2) any APO (gestational diabetes, hypertensive disorders of pregnancy, or preterm birth). We quantified annual average percent change (APC) from 2016-2020. Lastly, we pooled data from 2016-2020 and determined odds ratios (OR) of counseling comparing individuals with and without RFs, adjusted for age, education, postpartum insurance, and year of delivery. Results: Among 206,080 individuals (weighted N = 10,630,861), 89.8% (95% confidence interval 89.6-90.1%) attended a postpartum visit. In 2016, 57.6% (56.7%-58.5%) reported CVH counseling. From 2016-2020, counseling was similar or experienced small declines overall (APC -1.1%/year [-1.3, -0.8]), for any pre-pregnancy CVH factor (-0.2%/year [-1.1, 0.7]) and any APO (-1.5%/year [-2.2, -0.8]). Counseling was modestly higher among those with any pre-pregnancy CVH factor (OR 1.2 [1.2, 1.3]) or any APO (OR 1.1 [1.1, 1.2]) compared with individuals without RF (TABLE). Conclusions: Of the 9 of 10 individuals who attended a postpartum visit, only about half reported CVH counseling, even among those with poor pre-pregnancy CVH or APOs without improvement in the past 5 years. Multilevel efforts should prioritize the postpartum period as an opportunity for CVH promotion.