Peripartum Care Research Articles

Enhancing Maternal Comfort: The Impact of Endorphin Massage Therapy on Reducing Preoperative Pain and Anxiety in Primigravida Mothers Undergoing Cesarean Section

Pain and anxiety are significant challenges for primigravida mothers undergoing cesarean sections, with potential adverse effects on both maternal and neonatal outcomes. Endorphin massage therapy has emerged as a non-pharmacological intervention to mitigate these challenges by promoting the release of endorphins, which act as natural analgesics and anxiolytics. This study aimed to evaluate the effectiveness of endorphin massage therapy in reducing preoperative pain and anxiety levels in primigravida mothers scheduled for cesarean sections in Lubuklinggau, Indonesia. A quasi-experimental design was employed, involving 21 primigravida mothers divided into intervention and control groups. The intervention group received endorphin massage therapy, administered twice daily for three consecutive days prior to the cesarean section. Pain and anxiety levels were measured using the Numeric Rating Scale (NRS) and the Hamilton Anxiety Rating Scale (HARS), respectively. Statistical analyses were conducted to compare the pre- and post-intervention scores. The study found a significant reduction in both pain (mean difference: -4.3; 95% CI: -1.92 to -8.71; p < 0.001) and anxiety levels (mean difference: -8.3; 95% CI: -2.1 to -11.2; p < 0.001) in the intervention group compared to the control group. The reduction in anxiety was more pronounced than in pain, indicating the potent anxiolytic effect of endorphin massage therapy. Endorphin massage therapy significantly reduces preoperative pain and anxiety in primigravida mothers undergoing cesarean sections, particularly in alleviating anxiety. This non-pharmacological intervention could be a valuable addition to standard peripartum care, offering a safe, cost-effective alternative to pharmacological treatments. Further research with larger sample sizes is recommended to confirm these findings and explore long-term outcomes.

Peripartal COVID-19-Related Restrictions and Psychological Burden - A Quantitative Survey in Austria

The period from pregnancy to postpartum is a vulnerable time with an increased risk of mental illness. The COVID-19 pandemic led to restrictions in peripartum care, such as infection control measures, or restrictions regarding accompanying persons. Effects of COVID-19-related restrictions on the psyche and well-being during the peripartum period in Austria were retrospectively assessed using a partially standardized online questionnaire. In addition to closed questions on restrictions and psychological stress, this also contained the Edinburgh Postnatal Depression Scale (EPDS). Data from 850 women who had given birth during the pandemic were included in the analysis. In 8.5% of cases, appointments were canceled during prenatal care, 10.7% had to wear a face mask during the birth. One in 10 women had to cope with the birth and one in 5 with the puerperium without a companion. Unaccompanied women were significantly less likely to feel well cared for during the birth, more likely to feel alone in the puerperium and, according to the EPDS score, were more likely (39% vs. 20%; p<0.001) to have a high probability of postpartum depression. The pandemic-related restrictions led to anxiety, worry, loneliness and an increased risk of depression during the peripartum period. The balance of mental health was negatively affected by measures and restrictions. Even in times of pandemic, more attention needs to be paid to the vulnerable peripartum period.

A Survey of Obstetric Anaesthesia Services and Practices in the United Kingdom.

Background Variability in obstetric anaesthetia practice and care delivered within the UK is under-explored. The ObsQoR study explored structures, processes, and outcomes of obstetric anaesthesia in 107 hospitals within the UK's National Health Service, and the results of the hospital-level survey are reported here. Methods Hospitals were surveyed to assess obstetric anaesthesia provision, practice, and care delivery. Questions explored staffing, service provision and training, facilities present, clinical practices, outcome measurement, and key indicators of quality in obstetric anaesthesia. Results We received responses from 106 participating hospitals, representing 69% of all UK obstetric units. One hundred (94%) hospitals had a dedicated consultant obstetric anaesthetist within working hours, with 27 (25%) of hospitals' duty anaesthetists having additional clinical responsibilities outside the care of obstetric patients outside of working hours. Around 102 hospitals (98%) offer multidisciplinary team training, of which 95 (93%) use a simulation-based method. Dedicated high-risk antenatal clinics were present in 50 (47%) hospitals. The majority of hospitals provide written patient information in multiple languages for discussing obstetric anaesthesia options (77, 82%). Seventy-three hospitals (69%) use point-of-care testing to estimate haemoglobin concentration. Labour epidural analgesia is most commonly delivered via patient-controlled epidural analgesia in 80 (76%) hospitals, and the incidence of post-dural puncture headaches was recorded by 80 (76%) hospitals. Conclusions These results demonstrate variation in the provision of staffing, facilities, clinical practices, and outcome measurements across the UK. To deliver safe and equitable care across the UK, there needs to be standardisation of anaesthetic peripartum care based on national recommendations and the benchmarking and measurement of appropriate markers of quality.

Obstetric Anal Sphincter Injury Care Bundle: A Quality Improvement Initiative.

The objective was to implement an evidence-based peri-partum care bundle for women sustaining obstetric anal sphincter injuries and to evaluate compliance with recommendations for antibiotics use, repair in the operating room, and follow-up before and after implementation. This project was reviewed by the Institutional Review Board and determined to be exempt. A clinical care bundle containing education and standardized orders in the electronic medical record was implemented. Characteristics of pre- (October 2017 to September 2019) and post-intervention (October 2019 to August 2021) cohorts were compared and compliance with recommendations for antibiotics use, surgical repair location, and follow-up were evaluated. Chi-squared, Fisher's exact, ANOVA F, and Kruskal-Wallis tests were performed, as indicated. Significance level was p < 0.05. A total of 185 cases were identified. Seventy-five percent of women were nulliparous. Mean gestational age was 39weeks. Pre- and post-intervention groups did not differ in age, BMI, race, parity, gestational age, comorbidities, birthweight, or delivery type. Ninety-eight cases were identified pre-implementation. Eighty-six (88%) had third-degree lacerations. Post-implementation, 87 cases were identified. Seventy (80%) had third-degree lacerations (p = 0.17). Recommended antibiotic-type use improved from 35% pre-implementation to 93% post-implementation (p < 0.001). Repair in the operating room was similar pre-implementation and post-implementation (16.0% vs 12.6%, p = 0.48). Post-partum follow-up within 2weeks improved from 16.3% pre-implementation to 52.8% post-implementation and mean time to follow-up was shorter post-implementation than pre-implementation (18 vs 33days; both p < 0.001). Implementation of an evidence-based peri-partum care bundle resulted in standardization of care in accordance with established recommendations. Compliance with recommendations for surgical repair in the operating room remained unchanged.

Timeliness and quality of peripartum care provision during a health system strengthening initiative in rural Guinea-Bissau: a qualitative situation analysis

Guinea-Bissau has among the world’s highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.

Accessing peripartum care in an internal medicine clinic: Barriers, interventions, and racial disparities

Objective This study evaluates obstacles peripartum patients with additional medical needs face and services that would be helpful in obtaining this care. Study Design A survey was administered to 226 patients at a clinic specializing in internal medicine care for peripartum patients. Data was analyzed through descriptive statistics and linear regression. Results The three most reported barriers that interfered with attending medical appointments included the inability to leave work (41%), being too busy (33%), and lack of childcare (29%). Hispanic and Black patients reported more barriers to care as compared to White patients. The three most reported interventions that would be helpful in attending appointments were more virtual appointment options (38%), increased insurance coverage (31%), and provision of childcare (30%). Interventions were widely rated as helpful regardless of barriers faced and race reported. Conclusions Targeted interventions are needed to enhance access to peripartum care, especially for patients from marginalized racial and ethnic populations.

6299171 Peripartum care of a patient with severe left ventricular dysfunction diagnosed following COVID-19 infection.

6299171 Peripartum care of a patient with severe left ventricular dysfunction diagnosed following COVID-19 infection.

Increased Risk of Adverse Pregnancy Outcomes With Prior COVID-19 Infection [ID 2683650

INTRODUCTION: Prior retrospective studies found that COVID-19 infection during pregnancy is associated with an increased risk of adverse pregnancy outcomes such as preeclampsia, gestational diabetes, and preterm labor. Our study aims to investigate the risks of adverse pregnancy outcomes associated with COVID-19 infection acquired at least 3 months prior to pregnancy. METHODS: De-identified data was obtained from the TriNetX database. Population was stratified to compare women of childbearing age (15–45 years old) who contracted COVID-19 within 3–12 months prior to pregnancy to women without a history of COVID-19. Outcomes were measured within 1 year of pregnancy diagnosis to assess the effects of COVID-19. Statistical analyses used risk ratios (RRs) and P-values less than .05 to measure significance. RESULTS: This study identified 5,578 patients who contracted COVID-19 3–12 months prior to pregnancy and 970,218 patients without COVID-19 prior to matching for demographics and diagnoses. Cohorts were balanced (n=5,578 per cohort) using (1:1) propensity score matching for age, sex, race/ethnicity. Patients who contracted COVID-19 prior to pregnancy had a higher risk for preeclampsia (RR 1.428; P&lt;.0001), fetal growth restriction (RR 5.613; P&lt;.0001), and antepartum hemorrhage (RR 1.649; P&lt;.0001). Preterm labor, death, and gestational diabetes were not significant. CONCLUSION: Patients who contracted COVID-19 between 3 and 12 months prior to pregnancy have an increased risk for preeclampsia, fetal growth restriction, and antepartum hemorrhage compared to patients without COVID-19. Further investigation is warranted to validate these findings in prospective studies and to guide peripartum care for this population.

Changes in peripartum care and outcome in Estonia 1992–2021: Comparison of two periods based on data from Estonian medical birth registry

Changes in peripartum care and outcome in Estonia 1992–2021: Comparison of two periods based on data from Estonian medical birth registry

Peripartum care of pregnancy complicated by sjogren syndrome

Peripartum care of pregnancy complicated by sjogren syndrome

A qualitative exploration of the challenges providers experience during peripartum management of patients with a body mass index ≥ 50 kg/m2 and recommendations for improvement.

The objective of this research was to conduct a qualitative study among a diverse group of providers to identify their clinical needs, barriers, and adverse safety events in the peripartum care of people with a body mass index (BMI) ≥ 50 kg/m2. Obstetricians, anesthesiologists, certified nurse midwives, nurse practitioners, and nurses were invited to participate in focus group discussions if they were employed at the hospital for >6 months. Key concepts in the focus group guide included: (1) Discussion of challenging situations, (2) Current peripartum management approaches, (3) Patient and family knowledge and counseling, (4) Design and implementation of a guideline (e.g., checklist or toolkit) for peripartum care. The audiotaped focus groups were transcribed verbatim, uploaded to a qualitative analysis software program, and analyzed using inductive and constant comparative approaches. Emerging themes were summarized along with representative quotes. Five focus groups of 27 providers were completed in 2023. The themes included staffing (level of experience, nursing-patient ratios, safety concerns), equipment (limitations of transfer mats, need for larger sizes, location for blood pressure cuff, patient embarrassment), titrating oxytocin (lack of guidelines, range of uses), monitoring fetal heart rate and contractions, patient positioning, and communication (lack of patient feedback, need for bias training, need for interdisciplinary relationships). Providers gave examples of items to include in a "BMI cart" and suggestions for a guideline including designated rooms for patients with a BMI ≥ 50 kg/m2, defining nursing ratios and oxytocin titration plans, postpartum incentive spirometer, and touch points with providers (nursing, physicians) at every shift change. Providers discussed a range of challenges and described how current approaches to care may negatively affect the peripartum experience and pose threats to safety for patients with a BMI ≥ 50 kg/m2 and their providers. We gathered information on improving equipment and communication among providers.

Emerging Subspecialties in Neurology: Women's Neurology.

The influence of sex and gender on neurologic disease has become increasingly recognized in science and medicine. This is evident across a woman's lifespan especially during periods of hormonal transitions. Leaders in neurology have advocated for the importance of sex and gender-enriched clinical care, education, and research. The scope of women's neurology spans across a woman's life including puberty, adolescence, peripartum care, menopause, and aging. Women's neurology is a new subspecialty that aligns with a specific patient population and intersects with established neurology subspecialties and other specialties such as obstetrics, maternal fetal medicine, endocrinology, and psychiatry. Its establishment and collaboration with existing and emerging fields enables a more comprehensive approach to neurologic illness through the lens of sex and gender. Women's neurology is rapidly evolving through increased focus at academic centers, including expanded women's neurology curricula, dedicated women's neurology fellowship programs, improved understanding of sex and gender issues in neurosciences, and expansion of therapeutic options. Herein, we describe the history of the women's neurology field, emerging need for women's neurology specialists, information about training and career opportunities, and future directions.

Peripartum care provision in a resource-constrained setting – a qualitative study from Guinea-Bissau

Abstract Background Guinea-Bissau has among the world's highest maternal-perinatal mortality. Here, the European Union financed a national health system strengthening initiative to improve access to quality peripartum care from 2013-21. Thereafter, the initiative was supported by the World Bank. We conducted a situational analysis to explore factors shaping the provision of timely and quality peripartum care amid this transition in rural Guinea-Bissau. Methods We conducted in-depth interviews with eight peripartum care providers in four rural regions, and participant observations (192 hours) at the regional hospital and a health center in one region in 2021-22. Interviews and observation notes were analyzed using thematic network analysis aided by theories of social practice and the WHO framework for quality maternal and newborn health care. Results Peripartum services were provided under severely resource-constrained conditions. Care providers especially experienced a lack of materials (e.g., essential drugs, consumables, appropriate equipment), space and staffing, and commonly voiced feeling overburdened. Material constraints were explained by discontinued donor supplies. To navigate this context, providers used several tactics, including: delegating monitoring and support tasks to birth companions; prescriptions of materials for purchase; omitting tests; and using materials thrifty, e.g., by shifting tasks requiring gloves to the staff member wearing them or rationing disinfectants. These tactics had several consequences: diffusion of health worker responsibilities; financial barriers to care; delays; unsanitary conditions; and compromised occupational and patient safety. Conclusions With provision of quality peripartum care being highly dependent on external support amid scarce domestic resources, support disruptions led to severely compromised care. This highlights the need to strengthen donor-coordination warranting continuity and quality of essential health services. Key messages • Disruptions in donor support led to severely compromised peripartum care in rural Guinea-Bissau. • This underscores the need for strengthened donor-coordination warranting continuity of service quality.

Women’s perspectives of nitrous oxide for labour and procedural analgesia: A prospective clinical audit and cross-sectional study. “It’s the best thing”

ProblemThere is limited data regarding dose and duration of nitrous oxide use by women in peripartum care. Experiences of using nitrous in Australian settings have not previously been explored BackgroundMore than 1:2 women use nitrous oxide analgesia during labour and birth, despite this, there are limited published data on nitrous oxide use for labour or procedural analgesia in Australia. AimTo explore the use of nitrous oxide during labour and birth or procedural care. MethodsA two-phased sequential design was used; clinical audit (n = 183) and cross-sectional survey (n = 137) approaches supported data collection. Quantitative data were analysed using descriptive and inferential statistics, qualitative data underwent content analysis. FindingsNitrous oxide was used by primiparous and multiparous women evenly. Duration of labour-use ranged from < 15 min (10.9%) to > 5 h (10.8%), with equal representation between > 50% concentration (43%) and < 50% (43%). At audit, 75% found nitrous useful; postpartum maternal satisfaction scores remained high, mean indicators were 75%. More multiparous women found nitrous oxide useful than primiparous (95%vs80%,p = 0.009). There was no association between perceived usefulness and whether women were in spontaneous, augmented or induced labour; regardless of concentrations reached. Three key themes described women’s perspectives of physical and psycho-emotional effects and challenges. DiscussionNitrous oxide plays an important role in the provision of analgesia during procedural or labour and birth care. Service provision, parent and professional education, and future service design will benefit from these novel findings confirming the utility and acceptability of nitrous oxide use in contemporary maternity care.

Predictors and social determinants of HIV treatment engagement among post-partum Black women living with HIV in southeastern United States.

Guided by Mcleroy's socio-ecological model, this study explored the predictors and social determinants of HIV treatment engagement among Black post-partum women living with HIV. Quantitative, research methodology. We conducted a retrospective, secondary data analysis of 143 Black post-partum women living with HIV who received peripartum care in South-Florida, United States, from 2009 to 2017. We examined odds of immediate post-partum engagement at 3 months post-partum, and ongoing primary care engagement at 12 months post-partum. The independent group analyses showed low levels of immediate post-partum (32.9%) and ongoing primary care engagement (24.5%). At the intrapersonal level, maternal prenatal health significantly affected both immediate post-partum and ongoing primary care engagement; and at the interpersonal level, HIV disclosure and intimate partner violence/abuse significantly affected immediate post-partum engagement. Also, immediate post-partum disengagement was a significant predictor for ongoing primary care disengagement. This study provides timely and critical information to address recent calls for awareness and interventions to address issues on health disparities and inequities among racialized communities. The study provides significant evidence on the effects of social determinants of health on health outcomes for Black women living with HIV. Critical understanding and assessment of these factors, together with proper, proactive interventions may help to gauge such negative effects. Healthcare providers taking care of Black women living with HIV ought to be cognizant of these factors, assess at-risk women and intervene accordingly to ensure that their care is not marginalized. This study includes direct patient data from Black post-partum women living with HIV who were seen at prenatal and post-partum clinics wherein data for this study were obtained. The study results were presented locally, nationally and internationally to communities, organizations of healthcare providers, stakeholders and service-users, who further corroborated our findings, and provided insights and future recommendations.

Preventing and Treating Torsades de Pointes in the Mother, Fetus and Newborn in the Highest Risk Pregnancies with Inherited Arrhythmia Syndromes.

The number of women of childbearing age who have been diagnosed in childhood with ion channelopathy and effectively treated using beta blockers, cardiac sympathectomy, and life-saving cardiac pacemakers/defibrillators is increasing. Since many of these diseases are inherited as autosomal dominant, offspring have about a 50% risk of having the disease, though many will be only mildly impacted during fetal life. However, highly complex delivery room preparation is increasingly needed in pregnancies with inherited arrhythmia syndromes (IASs). However, specific Doppler techniques show meanwhile a better understanding of fetal electrophysiology. The advent of fetal magnetocardiography (FMCG) now allows the detection of fetal Torsades de Pointes (TdP) ventricular tachycardia and other LQT-associated arrhythmias (QTc prolongation, functional second AV block, T-wave alternans, sinus bradycardia, late-coupled ventricular ectopy and monomorphic VT) in susceptible fetuses during the second and third trimester. These types of arrhythmias can be due to either de novo or familial Long QT Syndrome (LQTS), Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), or other IAS. It is imperative that the multiple specialists involved in the antenatal, peripartum, and neonatal care of these women and their fetuses/infants have the optimal knowledge, training and equipment in order to care for these highly specialized pregnancies and deliveries. In this review, we outline the steps to recognize symptomatic LQTS in either the mother, fetus or both, along with suggestions for evaluation and management of the pregnancy, delivery, or post-partum period impacted by LQTS.

Implementation of a Severe Maternal Morbidity Quality Review Process at a Level IV Public Hospital [ID: 1377992

INTRODUCTION: Severe maternal morbidity (SMM) is tracked by national organizations offering opportunities to evaluate, monitor, and address in near real time. Using a multidisciplinary case review committee to analyze all cases of SMM at a level IV inner-city hospital, we hypothesized that case reviews will identify opportunities for improvement in obstetric practices. METHODS: A case review was triggered for any delivery with an SMM ICD-10 code, transfusion of greater than 4 units, readmission within 48 hours of discharge, a patient safety concern by staff, or a severe adverse neonatal outcome. This cohort study included all of the case reviews of cases between 2019 and 2022. Severe maternal morbidity outcomes, demographics, and obstetric practices were analyzed. RESULTS: Of 36,671 deliveries, 296 (0.8%) met criteria and were reviewed. Of these, 80 (27%) had two or more concurrent SMM events. Postpartum hemorrhage was the most common (37%), followed by intensive care unit admission (13%) and hysterectomy (12%). After review, practices done well included interdisciplinary communication and prompt decision-making. Opportunities for improvement included inadequate access to peripartum care due to socioeconomic barriers, communication, and lack of role clarity. CONCLUSION: Social barriers, inadequate communication, and lack of role clarity were identified as the most common areas of improvement in SMM cases. These findings led to the development of an escalation of care pathway for massive transfusion protocol and vital signs thresholds at which to contact anesthesia. The implementation of a standardized SMM surveillance system results in systematic improvements in obstetric practices.

The need for maternal critical care education, point-of-care ultrasound and critical care echocardiography in obstetric anesthesiologists training

Globally, the increase in medically complex obstetric patients is challenging the educational approach and clinical management of critically ill obstetric patients. This increase in medical complexity calls into question the educational paradigm in which future physicians are trained. Obstetric anesthesiologists, physician experts in the perio-perative planning and management of complex obstetric patients, represent an essential workforce in the strategies to address maternal mortality. Unfortunately, the development of peri-operative medicine and maternal critical care curricula has only received minor attention in most countries.Proposed guidelines and models highlight the existing need for tiered maternity care services in which critical care infrastructure plays a central role in the delivery of high-risk peripartum care. Therefore, the development of maternal critical care models designed to prepare obstetric anesthesiologists for the clinical challenges of a medically complex patient are warranted. Key critical care topics such as advanced ultrasonography, with the inclusion of quantitative echocardiographic assessments into obstetric anesthesiology educational curricula, will serve to better prepare physicians for the realities of an increasingly complex pregnant patient population, and further reinforce the critical care infrastructure detailed in the Levels of Maternal Care consensus.Despite an increasingly complex obstetric patient population, heterogeneity of maternal critical care practices exists across the globe, warranting standardization and further development of proposed curricula.

A Strategy for Reducing Maternal Mortality in Rural Kenya.

Migori County is categorized among regions with worst maternal survival rates in Kenya. The county's current maternal mortality ratio (MMR) is 673 deaths per 100000 live births. A need exists for a context-specific strategy to mitigate the persistent high maternal mortalities in rural Kenya. The researchers aimed to develop a strategy for reducing the maternal mortality ratio (MMR) in Migori, Kenya. An explanatory sequential mixed methods design was utilised. The design was characterised by two separate studies, an initial quantitative followed by a qualitative study. The final phase entailed integration of data from the two separate studies. The findings, extensive literature review and three delays of maternal mortality theoretical framework informed the development of the strategy. The strategy for implementation considered three strategic areas, namely, interventions targeting first delays, interventions targeting second delays, interventions targeting third delays. The priority interventions needed are those that enable: 1) Pregnant mothers to receive quality peripartum care in Migori hospitals, 2) Strengthened and efficient referral systems of obstetric emergencies and 3) Community knowledge empowerment on safe pregnancy and culture shift. These interventions would significantly transform the health-care system towards maternal mortality reduction. The Kenyan government and non-profit organisations should be involved in the implementation of the proposed strategy.

Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention.

Hypertension is a major, modifiable risk factor for cardiovascular disease (CVD) in the United States. Over the past decade, the prevalence of chronic hypertension (CHTN) during pregnancy has nearly doubled with persistent race- and place-based disparities. Blood pressure elevations are of particular concern during pregnancy given higher risk of maternal and fetal morbidity and mortality, as well as higher lifetime risk of CVD in birthing individuals with CHTN. When identified during pregnancy, CHTN can, therefore, serve as a lens into CVD risk, as well as a modifiable target to mitigate cardiovascular risk throughout the life course. Health services and public health interventions that equitably promote cardiovascular health during the peripartum period could have an important impact on preventing CHTN and reducing lifetime risk of CVD. This review will summarize the epidemiology and guidelines for the diagnosis and management of CHTN in pregnancy; describe the current evidence for associations between CHTN, adverse pregnancy outcomes, and CVD; and identify opportunities for peripartum care to equitably reduce hypertension and CVD risk throughout the life course.