128. Cardio-Obstetrics: Hypertensive Disorders of Pregnancy with Dr. Jennifer Lewey

Cardionerds: A Cardiology Podcast

CardioNerds (Amit Goyal and Daniel Ambinder), Cardio-OB series co-chair and University of Texas Southwestern Cardiology Fellow, Dr. Sonia Shah, and episode lead and Columbia University Cardiology Fellow Dr. Ersilia DeFilippis discuss hypertensive disorders of pregnancy (HDP) with Dr. Jennifer Lewey from the University of Pennsylvania. In this episode, we cover chronic hypertension, gestational hypertension, and pre-eclampsia—all of which encompass HDP and complicate approximately 5-10% of all pregnancies. We also review risk factors for HDP, diagnostic criteria, peripartum and postpartum management, and much more! Be sure to tune in to hear Dr. Lewey discuss the future impact of HDP on cardiovascular disease for women later in life and strategies that can help improve care. Finally Dr. DeFilippis shares her perspectives from her ACC.org FIT Section article titled “Shattering the Glass” including strategies to shattering the glass and tackling imposter syndrome in improving the representation of women in medicine. Audio editing by CardioNerds Academy Intern, Leticia Helms. Claim free CME for enjoying this episode! Pearls • Quotables • Notes • References • Guest Profiles • Production Team CardioNerds Cardio-Obstetrics Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls To make a diagnosis of HDP, blood pressure should be measured on at least 2 occasions at least 4 hours apart.Hypertension diagnosed before 20 weeks gestation is considered chronic hypertension whereas hypertension after 20 weeks is categorized as gestational hypertension.Always check for warning signs for pre-eclampsia!One of the key treatments for pre-eclampsia is delivery but pre-eclampsia can occur still in the postpartum period.Aspirin use in pregnancy during second and third trimesters can reduce the risk of pre-eclampsia among women at risk. Quotables “Ideally a lot of these conditions come down to prevention and addressing potential cardio-obstetrics issues before they reach the cardio-obstetrics specialist.” “Blood pressure can continue to be elevated even after delivery.” “Pregnancy complications not only increase cardiovascular risk in the middle age population but also in the postmenopausal population.” “Women feel so relieved when they know that their care team is dedicated to taking care of women with cardiovascular disease when they are pregnant.” Show notes Why should CardionNrds learn and know about hypertensive disorders of pregnancy? Hypertensive disorders of pregnancy (HDP) complicate about 5-10% of all pregnancies. HDP is a term that encompasses chronic hypertension, gestational hypertension, pre-eclampsia, and pre-eclampsia superimposed on chronic hypertension. Women with history of HDP are at increased risk for stroke, ischemic heart disease, and cardiovascular death later in life. It is important to include obstetric history as part of our assessment of cardiovascular risk. This obstetric history should include the number of pregnancies, history of gestational diabetes, gestational hypertension, history of pre-eclampsia as well as history of pre-term birth. Following delivery, these women need close monitoring for development of chronic hypertension as well as primary prevention of cardiovascular disease. 2. How is gestational hypertension distinguished from chronic hypertension? The key factor in distinguishing gestational hypertension from chronic hypertension is the timing of diagnosis. Before 20 weeks gestation, elevated blood pressure (defined as a reading > 140/90 on two occasions at least 4 hours apart) is considered chronic hypertension. After 20 weeks gestation, elevated blood pressures signify a pregnancy-induced process, namely gestational hypertension or pre-eclampsia if blood pressure elevati...