Few Women Screened for Diabetes, Dyslipidemia Postpartum

Screening for cardiovascular risk factors after pregnancy-related hypertension or diabetes may be suboptimal during the year after giving birth, data indicated.

In a population-based cohort study that included more than one million patients, fewer than 1 in 5 women with hypertension disorders of pregnancy or gestational diabetes were screened for diabetes and dyslipidemia after their pregnancy.

“If you or someone you know and care about has had a pregnancy with these complications, be aware to ask if screening is appropriate,” study author Amy Yu, MD, associate professor of medicine at the University of Toronto and adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada, told Medscape Medical News.

The findings were published on February 17 as a research letter in Circulation.

‘A Missed Opportunity’

Cardiovascular disease is the leading cause of death among women. Patients who develop hypertensive disorders of pregnancy or gestational diabetes are at increased risk for a future stroke or cardiovascular event. Screening for hypertension, cholesterol, and blood sugar is important for controlling heart disease risk factors, said Yu.

“Diabetes Canada has long recommended annual screening for diabetes after gestational diabetes, and in 2016, the Canadian Cardiovascular Society recommended dyslipidemia screening in women with a history of hypertensive disorders of pregnancy. We wanted to see how many of these women are then followed for risk factors that could affect their risk of heart disease and stroke,” she said.

The investigators examined data for 1,265,015 women aged younger than 50 years in Ontario, Canada, who were discharged after admission for live birth, stillbirth, or pregnancy termination between 2002 and 2019. They compared screening for diabetes and dyslipidemia in the first 3 years after delivery between women who developed pregnancy-related hypertension or diabetes (the exposed group) with those who did not (the unexposed group).

Exposed patients were older than unexposed patients (median age, 32 years vs 30 years), and 81.1% of exposed patients had pregnancy-related hypertension or diabetes during the index pregnancy. The remainder were exposed during a previous pregnancy.

Overall, 17.3% of women with gestational diabetes or hypertension were screened in the year following their pregnancy, and less than half (44%) were screened for dyslipidemia within 3 years of giving birth. Notably, most glycemic (87.8%) and lipid (93.7%) screening tests were ordered by family doctors.

The rate of screening for dyslipidemia was lower than the rate of screening for diabetes, and screening practices remained similar over the 17-year study period, despite increasing evidence that maternal health during pregnancy is associated with long-term vascular health, Yu pointed out.

The next step is to determine why at-risk women are not being screened, she added. “Is it because the women weren’t aware of their risk? Is it because they weren’t given the opportunity to go for testing? Or perhaps it’s such a busy time for women with a new baby at home, and it just falls off of the list of things to do,” she said.

Not screening for cardiovascular risk factors after pregnancy-related hypertension or diabetes is a missed opportunity for cardiovascular prevention, Yu added.

A Timely Letter

“I want to congratulate these authors for their timely research letter, which sheds light on the important notion of screening women with pregnancy-related complications for diabetes and dyslipidemias,” Roxana Mehran, MD, professor of medicine and director of the Women’s Heart and Vascular Center at Mount Sinai in New York, told Medscape Medical News.

It is crucial to raise awareness among all clinicians who provide healthcare to women about the need for timely screening for diabetes and hypertension, Mehran said. At the very least, the screening should be conducted soon after pregnancy. “It’s never too late or too early to do this for all women, but especially for women with adverse pregnancy events, screening should begin earlier.”

Prenatal care should include advice to women who develop these conditions to make sure they continue to undergo postpartum monitoring. “Referral to a primary care doctor or a cardiologist who can screen for premature coronary artery disease should also be considered,” she said.

The study was funded by ICES. Yu and Mehran reported no relevant financial relationships.