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Background: The American College of Obstetricians and Gynecologists and the American HeartAssociation recommend that women with hypertensive disorders of pregnancy be counseled on lifelongcardiovascular risks and transitioned to primary care for ongoing screening and management.Objective: To assess frequency and content of postpartum counseling regarding cardiovascular risk andfollow-up among women with hypertensive disorders of pregnancy.Study Design: A secondary analysis of a randomized trial of women with hypertensive disorders ofpregnancy, excluding chronic hypertension, performed at a single tertiary care academic hospital. Weabstracted documented counseling on hypertensive disorders from the discharge summary and postpartumvisit note in the electronic medical record. We defined counseling as documentation of any one of thefollowing: 1) recommending aspirin in a future pregnancy, 2) follow-up with primary care, or 3) lifelongrisk of cardiovascular disease. We used logistic regression models to estimate adjusted odds for receivingcounseling.Results: Seventy-four women enrolled in the study. A hypertensive diagnosis was documented for 71women (96.0%) in the discharge summary, but only 11 (14.9%) had any documented counseling in thedischarge summary or postpartum visit note. Of the 11 women counseled, 5 (6.7%) were counseled ontaking aspirin in a future pregnancy, 5 (6.7%) were counseled on follow-up with primary care, and only 3(4.1%) were counseled on the lifelong cardiovascular risk associated with hypertension in pregnancy. Twowomen (2.7%) were counseled on follow-up with primary care and lifelong cardiovascular risk. There wereno participants counseled on all three components. Later gestational age at delivery was associated withlower odds of counseling (adjusted OR 0.49, 95% CI 0.27-0.89).Conclusion: Despite consistent evidence on long-term risks of hypertensive disorders of pregnancy,counseling about those risks is suboptimal. Improved communication of risks is the first step towardsimproving maternal health in the “fourth trimester” and beyond.

Evaluation of Postpartum Counseling on Future Health Risks Associated with Hypertensive Disorders of Pregnancy