Postnatal primary care: Identifying opportunities for improving cardiovascular risk using the eLIXIR data linkage

Problem

There is a growing prevalence of cardiovascular disease, hypertension and diabetes in the UK and worldwide, and an increasing drive to prevent these individual conditions and associated multimorbidity. Pregnancy provides a ‘window into the future’, identifying women who are at particularly high risk. Following a hypertensive disorder of pregnancy (HDP) women are 4 times more likely to develop hypertension and twice as likely to die from cardiovascular disease in the following 20 years. Similarly, following gestational diabetes mellitus (GDM) women are 7 times more likely to develop type 2 diabetes than women who have not had gestational diabetes. While HDP and GDM are mainly managed antenatally by obstetrics and midwifery teams, postnatal follow up and long-term consequences are the remit of primary care. The long term sequalae of HDP and GDM are recognised in NICE guidelines for postnatal follow up of these conditions, but there is an absence of data on how often this follow up is missed, and whether this is patterned by socio-demographic factors.

Approach

This project aims to explore primary care follow up and physical and mental health outcomes in the first year postpartum, using routine data from the eLIXIR study. eLIXIR is a data linkage project combining maternity records from South London hospitals, general practice records, and mental health records collected on women attending maternity services in South London since October 2018.

Findings

Data linkage is currently in process. When data are available the following objectives will be assessed:• Are women being monitored in primary care (Attendance at 6 week check, monitoring of blood pressure and HbA1c) following hypertensive and diabetic pregnancies? • Does monitoring following hypertensive and diabetic pregnancies vary by socio-economic status (Index of Multiple Deprivation) and ethnicity? • Are postnatal physical (Blood pressure, HbA1c, medication use) and mental health (depression, anxiety, psychosis) outcomes different in women who have had hypertensive and/or diabetic disorders of pregnancy?

Consequences

An understanding of the care currently received and the early physical and mental health outcomes in women who have had HDP or GDM can be used to inform development of interventions to support this population to improve health for both future pregnancies and across the life course.