The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care.
The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care.
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DOI：
10.1007/s12170-022-00706-x
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发表时间：
2022
影响因子：
1.9
通讯作者：
Michos, Erin D
中科院分区：
文献类型：
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作者：
Choi, Eunjung;Kazzi, Brigitte;Varma, Bhavya;Ortengren, Alexandra R;Minhas, Anum S;Vaught, Arthur Jason;Bennett, Wendy L;Lewey, Jennifer;Michos, Erin D
“第四孕期”概念，定义为分娩后（及以后）的前12周，是临床医生干预以优化怀孕后妇女心血管健康的关键时间窗口。分娩后，所有妇女都应及时、全面地进行产后心血管评估，以便(1)跟踪妊娠前的医疗状况，(2)评估常见产后并发症的症状和体征，(3)识别危险因素并预防未来不良心血管结局。在这篇综述中，我们的目的是讨论主要的产妇心血管危险因素，如妊娠期高血压疾病、妊娠期糖尿病、产后体重潴留和产后抑郁，以及哺乳作为潜在的保护性风险调节因素。此外，我们将回顾门诊干预措施的有效性，以加强在第四孕期心血管护理的过渡。为了早期发现和管理高血压、体重、血糖控制、压力和情绪以及长期心血管风险，需要从产科无缝地转移到初级保健，并可能转移到心脏病学。此外，远程医疗、血压自我监测、远程活动监测和行为健康教练的使用是潜在可行的模式，以增加心血管危险因素和体重管理的临床护理，但需要进一步的研究来研究其长期有效性。制定全面的产后护理计划，仔细考虑每位患者的风险状况和获得资源的机会，对于提高孕产妇发病率和死亡率、缩小健康差距和实现妇女的长期心血管健康至关重要。在这一过渡时期支持妇女产后健康需要多学科方法，特别是初级保健参与，并应在分娩前开始规划。
The “fourth trimester” concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women’s cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester. A seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness. Development of a comprehensive postpartum care plan with careful consideration of each patient’s risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.