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.
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