Despite having risk factors for heart disease, only 60% of women reported receiving counseling on optimizing their heart health, which includes healthy eating, exercise and losing weight gained during pregnancy at their six-week postpartum visit between 2016 and 2020, a new Northwestern Medicine study has found.

About 90% of women in the U.S. attend at least one postpartum visit during what is commonly referred to as the "fourth trimester." For these women, who are already juggling other demands—such as adjusting to life with a new child and returning to work—this visit is considered one of the few times during the first year after pregnancy to prioritize their own health, the study authors said.

"We need to find ways to take advantage of this prime opportunity when we have a captive audience of people who are already in the doctor's office, talking about their health at a critical juncture in life," said corresponding author Dr. Sadiya Khan, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. "It is hard to create new opportunities. The fourth-trimester visit is an already-ready moment to prioritize maternal heart health."

The study, published July 25 in JAMA, is the first to describe contemporary rates of heart-health counseling during postpartum visits for women with heart disease risk factors or who experienced pregnancy complications. It found between 2016 and 2020, the frequency of heart disease risk factors—being overweight, having diabetes or high blood pressure and delivering preterm—increased among birthing adults.

"Our data show that reports of overall counseling are low. For people who have risk factors, lifestyle counseling during this critical time is a first step to reducing long-term risk of heart disease," said lead author Dr. Natalie Cameron, instructor of general internal medicine at Feinberg and a Northwestern Medicine physician.

"While the postpartum visit represents an opportunity to reach a large number of women, it is only the start," Cameron said. "Health care systems must improve continuity of care after pregnancy and help women find clinicians who can provide preventive care. These can be obstetricians/gynecologists, primary care clinicians or cardiologists, depending on the patient's needs and the clinician's expertise."

Remembering their counseling is key

It is important to note that more women may have received counseling but only 60% of women reported remembering that they received counseling on how to optimize their heart health, Khan said.

"I think it's important that we also prioritize implementation science research that identifies the best strategies for counseling to improve heart health, particularly in the first year after pregnancy," Khan said. "If counseling is provided but they don't remember it or it does not translate into improvements in heart health, it's not very effective."

What can be done?

From a structural level, systems and policies must support these health care transitions from pregnancy to postpartum and ensure women can access care throughout the first-year postpartum and beyond. Continuing to expand postpartum Medicaid coverage from 60 days to 12-months postpartum is a critical first step to improving access to care for the more than 40% of U.S. women who are insured by Medicaid during pregnancy, Cameron said.

"In the midst of the growing public health crisis around maternal health, we also need to continue to increase awareness of the importance of long-term cardiovascular health monitoring and optimization among women with adverse pregnancy outcomes," she said.

The study is titled, "Trends in cardiovascular health counseling among postpartum individuals." Other Northwestern co-authors include Dr. Lynn Yee, Dr. Brigid Dolan, Dr. Matthew O'Brien and Dr. Philip Greenland.