title: The maternal health clinic: an initiative for cardiovascular risk identification in women with pregnancy-related complications.
abstract: OBJECTIVE
  Women who develop certain common pregnancy complications have a greater chance of developing cardiovascular disease (CVD) later in life. However, most health care providers do not provide postpartum cardiovascular risk counselling or follow-up. The Maternal Health Clinic was established to address this gap in care. It targets women at increased risk of CVD to inspire lifestyle changes, encourage long-term follow-up, and initiate primary prevention. Here, we summarize results from the first 17 months of completed clinic visits.
  
  
  METHODS
  Patients experiencing at least one relevant complication in their index pregnancy were referred to the Maternal Health Clinic through standard postpartum order sheets. Patients underwent a complete assessment including screening history, physical examination, fasting bloodwork, and urinalysis. Lifetime and 30-year CVD risk estimates, along with a metabolic syndrome calculation, were determined for each patient.
  
  
  RESULTS
  Complications most commonly leading to referral were gestational diabetes or impaired glucose tolerance (32.7%), preeclampsia (29.3%), preterm birth (29.3%), and gestational hypertension (19.6%). The clinic analysis group (n = 92) was compared with a healthy control group from the PreEclampsia New Emerging Team study (n = 118). Patients in the clinic analysis group had significantly increased lifetime and 30-year CVD risk estimates compared with healthy controls (P < .0001). Furthermore, 17.4% of the clinic analysis group had metabolic syndrome, compared with 6.78% of healthy controls (P < .05).
  
  
  CONCLUSIONS
  This study demonstrates that the Maternal Health Clinic accurately identifies postpartum patients that have underlying cardiovascular risks which make them susceptible to CVD. The clinic may serve as an effective primary prevention strategy.
authors: Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
authors: Maria C
authors: MC
authors: Cusimano
authors: Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
authors: Jessica
authors: J
authors: Pudwell
authors: Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
authors: Michelle
authors: M
authors: Roddy
authors: Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
authors: Chan-Kyung Jane
authors: CK
authors: Cho
authors: Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
authors: Graeme N
authors: GN
authors: Smith
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008019:Life Style; D008427:Maternal Health Services / Q000458:organization & administration*; D017146:Models, Organizational; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011322:Primary Prevention / Q000458:organization & administration; D018570:Risk Assessment
keywords: cardiovascular diseases; maternal health clinic; pregnancy; pregnancy complications; risk factor