The prevalence of documented cardiovascular-related pregnancy complications: cross-sectional study in an academic primary care centre

Abstract

BackgroundPregnancy and the postpartum period offer a unique opportunity to identify patients with risk factors leading to premature cardiovascular disease (CVD), which often go unrecognised.AimThis study investigates self-reported prevalence of CVD-related pregnancy complications and its documentation in electronic medical records (EMRs) in an academic family health team (AFHT).Design & settingA retrospective cross-sectional survey conducted from 2016 to 2017 in an AFHT.MethodThe survey assessed self-reported pregnancy complications and obstetric histories of adult females. EMRs of responders who provided consent were appraised for documented pregnancy complications, and management of traditional cardiovascular risk factors post-pregnancy.ResultsOut of 211 responders, 28% (n= 60) had at least one pregnancy complication reported in the survey and/or in the EMR, of which 67% (n= 40) had the complication documented in their EMR. The most prevalent complications were preterm birth (PTB; 12%,n= 25), hypertensive disorders of pregnancy (HDP; 10%,n= 22), and gestational diabetes mellitus (GDM; 7%,n= 14). Twenty-nine per cent (n= 4) of the patients with GDM had a 75 g oral glucose tolerance test result documented post-pregnancy. Of those with HDP, 36% (n= 8) had body mass index and 50% (n= 11) had a blood pressure measurement recorded after delivery.ConclusionThere has been a significant lack of documentation of pregnancy-related cardiovascular risk factors and subsequent management, introducing a missed opportunity for early cardiovascular intervention. Adequate documentation of pregnancy complications in the EMR and better transitions in care between obstetric and primary care teams could potentially enable clinicians to intervene early and better manage females at increased risk of CVD.