Inadequate postpartum screening for hypertension and diabetes a 'missed opportunity' for women, study suggests

Less than one in five patients are tested for cardiovascular risk factors following pregnancy-related hypertension or diabetes, according to a new study published in the "Go Red for Women" issue of Circulation.

Cardiovascular diseases are a leading cause of death among women. People who develop hypertensive disorders of pregnancy or gestational diabetes are at a higher risk of experiencing a future stroke or heart disease. Screening for high blood pressure, lipids, and sugars plays a crucial role in the early diagnosis of risk factors for cardiovascular disease.

"There's increasing evidence that maternal health during pregnancy is associated with long-term vascular health," says Dr. Amy Yu, neurologist and senior scientist at Sunnybrook Research Institute, and adjunct scientist with ICES.

"Guidelines recommend that women with high blood pressure or sugar during pregnancy should have their blood sugar and cholesterol checked after the pregnancy, so we set out to evaluate whether Ontarians were getting these tests done."

Researchers from ICES and Sunnybrook Health Sciences Center studied over a million pregnant individuals in Ontario, Canada, between 2002 and 2019. They compared screening for diabetes and dyslipidemia in the first three years after delivery between those who developed pregnancy-related hypertension or diabetes (exposed group) and those who did not (unexposed group).

Key findings

• Fewer than one in five individuals (17%) diagnosed with gestational diabetes or hypertension were screened in the year following pregnancy.
• Less than half (44%) of individuals received these tests within three years. Rates for screening for high cholesterol were lower than screening for diabetes.
• Surprisingly, 33% of pregnant individuals without gestational diabetes or hypertension received these screening tests.

Given that the gap in screening was more prominent for lipids than diabetes, the authors suggest that access to physicians for cardiovascular preventive care may not be the main cause of these lower screening rates.

There may instead be a need for increased awareness of pregnancy-related cardiovascular disease risks among physicians and patients.

"Women should be aware of their risk for cardiovascular disease, so that they can ask their doctors about risk factor screening," says Dr. Yu, who is also an Associate Professor in Temerty Faculty of Medicine's Department of Medicine at the University of Toronto.

"Having this knowledge can also support patients' decision-making about lifestyle changes, which could improve their vascular health."