How GPs can best monitor vascular conditions in pregnancy

Common vascular conditions that can arise in pregnancy, such as hypertension and gestational diabetes, can significantly increase a woman’s future cardiovascular risk
 
Dr Wendy Burton is a GP and Chair of the RACGP Specific Interests Antenatal/Postnatal Care network. She believes that GPs, in conjunction with the maternity care team, play an important role in encouraging pregnant women to become more aware of their heart health and have regular heart checks.
 
Dr Burton encourages GPs to liaise with specialist colleagues early to seek advice regarding management of or referral for conditions during pregnancy that can potentially lead to poor heart health.
 
‘Good clinical handover with clear recommendations, such as the frequency and type of screening, is essential in antenatal care,’ she told newsGP. 
 
‘GPs are well schooled in preventive healthcare, screening for and managing risks, [so this can be effectively done if] GPs know what they need to do and have the appropriate information.’
 
With vascular conditions during pregnancy posing future heart health issues for women, the Heart Foundation has announced a multidisciplinary policy response and think tank as part of its Making the Invisible Visible campaign.
 
‘Heart disease remains a leading killer of Australian women, but it continues to be under-recognised, under-researched, and under-treated,’ Julie Anne Mitchell, Heart Foundation National Spokesperson on Women’s Heart Health, said.
 
‘Around 13% of pregnant women in Australia will develop gestational diabetes, which is associated with an increased risk of type 2 diabetes, and up to 30,000 women suffer from hypertensive disorders of pregnancy, such as pre-eclampsia, in Australia each year.
 
‘These conditions can increase women’s risk of cardiovascular disease later in life.’
 
From the patients’ perspective, Dr Burton believes it is critical that women are educated to better understand the importance of shared care. She said education and advice on lifestyle modifications to help prevent potentially harmful medical conditions in pregnancy start from preconception.
 
‘Good nutrition, regular exercise and achieving a healthy weight is always a good place to start,’ Dr Burton said.
 
Regular screening throughout pregnancy helps to ensure all members of the healthcare team are aware of any conditions or potential risks, particularly pre-eclampsia, which can arise from hypertension conditions during pregnancy, Dr Burton said. She recommends a number of screening approaches.
 
‘Identifying and managing pre-existing hypertension is important, and a preconception consultation with an obstetric physician should be considered for women at high risk [of hypertension],’ Dr Burton said.
 
‘Low dose aspirin – 75–100 mg – should be commenced from 12 weeks’ gestation for high-risk women.
 
‘GPs also need to be alert to the lower cut offs for blood pressure treatment – >150/90 – recommended in pregnancy, and proactively investigate for signs and symptoms of pre-eclampsia, which can cause significant mortality and morbidity for both mother and child and needs to be recognised and appropriately managed by every member of the maternity team.’
 
Dr Burton also stressed the importance of screening for and monitoring of gestational diabetes.
 
‘Gestational diabetes has significant long-term implications for women, as it increases their risk of developing diabetes and has a lifelong effect on cardiovascular risk,’ she said.
 
‘GPs should liaise with specialist colleagues early to seek advice regarding management or referral.’
 
Dr Burton emphasised that communication across the maternal care team significantly contributes to reducing risk of vascular and other conditions during pregnancy, and helps to ensure a woman’s future heart health.
 
‘We cannot help to manage a woman’s risk if we are not aware of it,’ she said. 
 
‘Pregnancy is a critical component of a woman’s journey and if GPs know the appropriate information we are ready, willing and able to help.’

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