Effect of Guideline Change on Preconception Counseling for Heart Disease in Pregnancy [A250]. (May 2022)

• Record Type: Journal Article
• Authors: Berra, Alexandra L.; Turrentine, Mark A.; Ramirez, Mildred A.
• Is Part Of: Obstetrics and gynecology. Volume 139(2022)Supplement 1
• Page Start: 72S
• Page End: 72S
• Publication Date: 2022-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000826276.08122.54
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: There is limited evidence that implementation of guidelines in preconception counseling improves pregnancy outcomes. In 2019, the American College of Obstetricians and Gynecologists' Pregnancy and Heart Disease Task Force developed a risk assessment score for cardiovascular disease based on symptoms, vital signs, risks factors, and physical examination. Women with a combined score of ≥4 are to be referred to maternal–fetal medicine (MFM) or primary care or cardiology (PCP) plus obtaining an electrocardiogram (EKG) with brain natriuretic peptide (BNP). Our objective was to estimate the effect of guideline changes on risk screening for cardiovascular disease during preconception counseling. METHODS: Retrospective chart review of women undergoing preconception counseling 6 months before versus 6 months after guidelines changed. We identified women with a combined score of ≥4 to evaluate if recommendations were followed. RESULTS: During the six months pre-publication, 174 women underwent preconception counseling, compared with 187 in the six months post-publication. Most women were screened by a reproductive endocrinology infertility (REI) physician (95% versus 83% in the pre versus post periods). Similar rates of women had a score of ≥4 in the two periods (5% versus 3%, P =.59). Referral to MFM or a PCP physician was high (88% versus 100%, P =.78), but there was no improvement for obtaining an EKG (88% versus 33%, P =.09) or BNP (0% versus 0%). CONCLUSION: Women with preconception counseling are being screened primarily by REI and are being referred to MFM/PCP, but are not consistently receiving recommended cardiovascular screening.