Table 1 Guidelines and targets for cardiovascular health assessment and management in the postpartum patient (https://www.acc.org//-/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Membership/Sections-Councils/Reproductive-Health-and-Cardio-Obstetrics/ACC-Post-Partum-Hypertension-Clinical-Toolkit.pdf)6,7,66
From: Advances in postpartum hypertension management: a review of current guidelines and interventions
Domain | Recommendations | Management and additional considerations |
|---|---|---|
Cardiovascular health metric | ||
Blood pressure | - Every visit; consider home monitoring | - Expect return to pre-pregnancy levels by 12 weeks - Target <120/80 mmHg ( < 130/80 mmHg if chronic HTN) |
Blood glucose | - 2-h oral glucose tolerance within 12 weeks postpartum, or fasting plasma glucose or hemoglobin A1c in first year postpartum | - Consider National Diabetes Prevention Program clinics if history of GDM |
Lipid panel | - Once in first year postpartum, target around 12 weeks postpartum | - Awareness of impact of lactation on lipid parameters |
Health behaviors | ||
Diet | - Educate on DASH or Mediterranean diet | - Consider referral to dietician |
Physical activity | - Goal 150 min/week of moderate activity, supervised by OBGYN in early postpartum period | - Recommendations per OBGYN in early postpartum period may vary depending on delivery mode |
Tobacco/Nicotine | - Total avoidance of tobacco or nicotine | - Employ behavioral, psychosocial, pharmacologic approaches to promote cessation as needed |
Weight management | ||
- Regularly assess weight +/− waist circumference with consideration of time since delivery - Educate on adverse effects of obesity on future reproductive and cardiovascular risk | - Consider dietician, weight loss clinic referral - Consider use of GLP1 or GLP1/GIP agonist in non-lactating/non-pregnant patient | |
Behavioral health | ||
Psychological health | - Screen at least once for postpartum depression with validated tool (ex. EDPS or PHQ-9) | - Consider behavioral health referral - Screen more frequently depending on patient risk |
Sleep | - Evaluate for sleep disturbance | |
Reproductive health | ||
Lactation | - Educate on cardiovascular benefit - Screen for lactation issues at least once | - Consider lactation consultant referral as needed - Consider when prescribing medications - Consider risk vs. benefit discussion regarding lactation duration vs. statin treatment in certain patients |
Contraception | - Screen at least once for contraceptive use to minimize risk of short interpregnancy interval | - LARC most effective option - Consider risk of exacerbated HTN with estrogen-containing oral contraceptives - Recommend if plan to use potentially teratogenic medications (ex. ACEi/ARB) |
Pregnancy planning | - Educate on importance of optimizing cardiovascular health prior to pregnancy and careful management during pregnancy to minimize APO reoccurrence risk | - Encourage contraceptive use as needed to facilitate this |
Social drivers of health | ||
- Screen at least once, consider EMR-based screening | - Construct list of local resources - Consider social work, nurse navigator, or postpartum doula to facilitate care coordination | |
