O119. Cardiovascular risk management after reproductive and pregnancy related disorders: A Dutch multidisciplinary evidence-based guideline

Abstract

Introduction In the past decades evidence has accumulated that women with reproductive and pregnancy related disorders are at increased risk of developing cardiovascular disease (CVD) in the future. Up to now there is no standardized follow-up of these women since guidelines on cardiovascular risk management for this group are lacking. However, early identification of high-risk populations followed by prevention and treatment of CVD risk factors has the potential to reduce CVD incidence. Objective The Dutch Society of Obstetrics and Gynaecology initiated a multidisciplinary working group (gynecologists, cardiologist, vascular internist, radiologist, general practitioner, epidemiologist and representatives of patient associations) to develop a guideline for cardiovascular risk management after reproductive and pregnancy related disorders. Methods The guideline was developed using the “Appraisal of Guidelines for Research and Evaluation” instrument. The guideline addresses the cardiovascular risk consequences of gestational hypertension, preeclampsia, preterm delivery, small-for-gestational-age infant, recurrent miscarriage, polycystic ovary syndrome and premature ovarian insufficiency. The best available evidence on these topics was gathered by systematic review and the relation between the reproductive or pregnancy related disorders and CVD risk and risk factors was assessed by meta-analysis. Recommendations for clinical practice were formulated based on the number and quality of the studies and presence or absence of a relative risk > 2 of developing CVD events and/or risk factors from the meta-analysis. The Dutch societies of gynaecologists, cardiologists, vascular internists, radiologists, and general practitioners endorsed the guideline to ensure support for implementation in clinical practice. Results For all reproductive and pregnancy related disorders only a moderate increased relative risk ( 2) was found for overall CVD, except for preeclampsia (relative risk 2.15, 95% CI 1.76–2.61). Based on the current available evidence, follow-up is only recommended for women with a history of preeclampsia. A cardiovascular risk profile should be offered at the age of 50 years. Assessment of CVD risk and treatment of cardiovascular risk factors should be performed according to the Dutch guideline for cardiovascular risk management. For all reproductive and pregnancy related disorders optimization of modifiable cardiovascular risk factors is recommended to reduce the risk of future CVD. Conclusion In this guideline we present the recommendations for cardiovascular risk management after reproductive and pregnancy related disorders. To the best of our knowledge we are the first to make such recommendations in a national guideline.