News from ACOG 2017: Despite being equated to failed stress test, primary care physicians seldom screen for history of preeclampsia.

Several studies have demonstrated that women with a history of preeclampsia have 2-4-fold increased risk of cardiovascular diseases(CVD) later in life, yet internist and family physicians seldom ask the women about this during a well women examination, reports a small study presented at American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting (ACOG)2017 in San Diego, California.   

This is a very small observational study conducted by Dr. Lewnard and her colleagues at the Medical College of Wisconsin, Milwaukee. They retrospectively reviewed the charts over a period of 2.5 years to see whether internal medicine physicians ask for history of preeclampsia during annual well woman examination visits.

The study included 89 women, who had at least one prior delivery. The researchers also scanned the charts to see whether they were asked about history of other CVD risk factors like diabetes, hypertension and smoking. 

All 89 women were asked about hypertension, 88 were asked about diabetes or smoking but just 21 were asked about history of preeclampsia. (P = .0002)

The study was conducted between January 1, 2013 to May 31, 2016 after ACOG and AmericanHeart Association had issued guidelines that recognized the elevated CVD risk for women with a history of preeclampsia.

AHA says “Healthcare professionals who meet women for the first time later in their lives should take a careful and detailed history of pregnancy complications with focused questions about a history of gestational diabetes mellitus, preeclampsia, preterm birth, or birth of an infant small for gestational age.”

The AHA also asked Ob/Gyns to refer these patients to a primary care physician for to control and modify the risk factors.

ACOG also recommends that those women who have history of preeclampsia and preterm delivery should have yearly assessment for total lipids, BMI, blood pressure and blood glucose.

Of the 89 patients in the study, 6 patients had confirmed history of preeclampsia and their demographics were similar to other patients. So, it was very important to ask the patients about prior obstetrics history in detail.

When Dr Lewnard asked the internists about missing the history of preelampsia, many replied that there are no clear-cut guidelines for assessing this risk factor. “There is a screening gap leading to missed opportunities to identify women at risk for cardiovascular disease,” opined Dr. Irene Lewnard.

“Preeclampsia meets or exceeds traditional risk factors for cardiovascular disease,” She further added.

Dr. Lewnard and her colleagues are looking at efficacy of adding prompts to electronic health record so that more women can be screened in the future by the primary care physician.

More on Preeclampsia and future risk of CVD:

Preeclampsia doubles the risk of future major fatal and nonfatal coronary event.

Pre-clinicalatherosclerosis persists up to 10 years after preeclamptic pregnancy.

History of preeclampsia linked to coronary artery calcification 30 years later.