Keele Research Repository

Background
Despite guidelines recommending the evaluation of adverse pregnancy outcomes (APOs) as a part of the atherosclerotic cardiovascular disease (ASCVD) risk assessment in women, there is limited awareness of this issue in healthcare professionals. We sought to evaluate the extent of this gap in knowledge.

Methods
An online study using a standardised questionnaire was advertised through newsletters and websites of professional organisations. Following a low response rate, the link to the survey was announced on Twitter and via personal email invitations. Differences between groups of respondents were evaluated with z-tests of proportion.

Results
Out of 446 complete responses, there were 315 cardiologists and 112 obstetricians and gynaecologists. There was an >90% awareness of association of adverse maternal outcomes with gestational hypertension and gestational diabetes with ASCVD, but only <60% awareness of association of adverse maternal outcomes with preterm birth. There were significant differences in ASCVD risk assessment and awareness of the association of APOs with adverse outcomes between cardiologists versus obstetricians and gynaecologists, and between female versus male cardiologists. A greater proportion of female cardiologists thought that the guidelines recommended annual follow-up for high-risk women. Conversely, a greater proportion of male cardiologists were unsure of the frequency of follow-up of such women in the relevant guidelines. A higher proportion of U.K. respondents thought that women with high-risk pregnancies should never be screened for cardiovascular disease postpartum compared with U.S. respondents.

Conclusions
In a self-selected group of healthcare professionals interested in women’s cardiovascular health, there remains a large gap in knowledge and awareness of the association of APOs with ASCVD risk, in particular a lack of awareness of the association of ASCVD risk with preterm delivery. Specific target groups for improving knowledge regarding these sex-specific risk enhancers include male cardiologists and healthcare professionals practising in the U.K.