Accepted for Publication: September 6, 2021.
Published Online: October 27, 2021. doi:10.1001/jamacardio.2021.4391
Corresponding Author: Michael C. Honigberg, MD, MPP, Massachusetts General Hospital, 185 Cambridge St, Mail Box CPZN 3.187, Boston, MA 02114 (mhonigberg@mgh.harvard.edu).
Author Contributions: Ms Jowell and Dr Honigberg had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Jowell, Sarma, Vaught, Natarajan, Powe, Honigberg.
Acquisition, analysis, or interpretation of data: Jowell, Gulati, Michos, Honigberg.
Drafting of the manuscript: Jowell, Vaught.
Critical revision of the manuscript for important intellectual content: Jowell, Sarma, Gulati, Michos, Natarajan, Powe, Honigberg.
Administrative, technical, or material support: Natarajan.
Supervision: Sarma, Gulati, Vaught, Honigberg.
Conflict of Interest Disclosures: Dr Sarma reported receiving grants from the National Heart, Lung, and Blood Institute (NHLBI) and a CRICO Patient Safety Award outside the submitted work. Dr Michos reported receiving personal fees from the advisory boards of Novartis International AG, Amarin Corporation, Esperion, Therapeutics Inc, and AstraZeneca outside the submitted work. Dr Natarajan reported receiving grants from Amgen Inc, Apple Inc, Boston Scientific Corporation, and AstraZeneca; personal fees from Apple Inc, Blackstone Life Sciences, Novartis International AG, Genentech/Roche, AstraZeneca, and Foresite Labs; and having a spouse who is employed by Vertex Pharmaceuticals Inc outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by grants R01HL142711, R01HL148050, R01HL148565, and R01HL151283 from the NHLBI (Dr Natarajan); grant TNE-18CVD04 from Fondation Leducq (Dr Natarajan); a Hassenfeld Scholar Award from Massachusetts General Hospital (Dr Natarajan); grant 5U01DK123795-02 from the National Institute of Diabetes and Digestive and Kidney Diseases (Dr Powe); and grant T32HL094301-07 from the NHLBI (Dr Honigberg).
Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Paul Bain, PhD, MLIS, Countway Library, Harvard Medical School, Boston, Massachusetts, assisted with the literature search without compensation.
1.Cain
MA , Salemi
JL , Tanner
JP , Kirby
RS , Salihu
HM , Louis
JM . Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes.
Am J Obstet Gynecol. 2016;215(4):484.e1-484.e14. doi:
10.1016/j.ajog.2016.05.047
PubMedGoogle ScholarCrossref 3.Song
C , Lyu
Y , Li
C ,
et al. Long-term risk of diabetes in women at varying durations after gestational diabetes: a systematic review and meta-analysis with more than 2 million women.
Obes Rev. 2018;19(3):421-429. doi:
10.1111/obr.12645
PubMedGoogle ScholarCrossref 4.Rosenbloom
JI , Stwalley
D , Lindley
KJ , Michael Nelson
D , Olsen
MA , Stout
MJ . Latency of preterm hypertensive disorders of pregnancy and subsequent cardiovascular complications.
Pregnancy Hypertens. 2020;21(May):139-144. doi:
10.1016/j.preghy.2020.05.015
PubMedGoogle Scholar 13.Schaaf
JM , Liem
SMS , Mol
BWJ , Abu-Hanna
A , Ravelli
ACJ . Ethnic and racial disparities in the risk of preterm birth: a systematic review and meta-analysis.
Am J Perinatol. 2013;30(6):433-450. doi:
10.1055/s-0032-1326988PubMedGoogle Scholar 14.Stuart
JJ , Tanz
LJ , Missmer
SA ,
et al. Hypertensive disorders of pregnancy and maternal cardiovascular disease risk factor development: an observational cohort study.
Ann Intern Med. 2018;169(4):224-232. doi:
10.7326/M17-2740
PubMedGoogle ScholarCrossref 19.Arnett
DK , Blumenthal
RS , Albert
MA ,
et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Circulation. 2019;140(11):e596-e646. doi:
10.1161/CIR.0000000000000678PubMedGoogle Scholar 25.Parikh
NI , Gonzalez
JM , Anderson
CAM ,
et al; American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women.
Circulation. 2021;143(18):e902-e916. doi:
10.1161/CIR.0000000000000961PubMedGoogle ScholarCrossref 29.Cusimano
MC , Pudwell
J , Roddy
M , Cho
CKJ , Smith
GN . The Maternal Health Clinic: an initiative for cardiovascular risk identification in women with pregnancy-related complications.
Am J Obstet Gynecol. 2014;210(5):438.e1-438.e9. doi:
10.1016/j.ajog.2013.12.001
PubMedGoogle ScholarCrossref 32.Celi
AC , Seely
EW , Wang
P , Thomas
AM , Wilkins-Haug
LE . Caring for women after hypertensive pregnancies and beyond: implementation and integration of a postpartum transition clinic.
Matern Child Health J. 2019;23(11):1459-1466. doi:
10.1007/s10995-019-02768-7
PubMedGoogle ScholarCrossref 35.Lewey
J , Levine
LD , Yang
L , Triebwasser
JE , Groeneveld
PW . Patterns of postpartum ambulatory care follow-up care among women with hypertensive disorders of pregnancy.
J Am Heart Assoc. 2020;9(17):e016357. doi:
10.1161/JAHA.120.016357
PubMedGoogle Scholar 37.Levine
LD , Nkonde-Price
C , Limaye
M , Srinivas
SK . Factors associated with postpartum follow-up and persistent hypertension among women with severe preeclampsia.
J Perinatol. 2016;36(12):1079-1082. doi:
10.1038/jp.2016.137
PubMedGoogle ScholarCrossref 39.Timpka
S , Stuart
JJ , Tanz
LJ , Rimm
EB , Franks
PW , Rich-Edwards
JW . Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses’ Health Study II: observational cohort study.
BMJ. 2017;358:j3024. doi:
10.1136/bmj.j3024
PubMedGoogle Scholar 40.Bao
W , Tobias
DK , Bowers
K ,
et al. Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study.
JAMA Intern Med. 2014;174(7):1047-1055. doi:
10.1001/jamainternmed.2014.1795
PubMedGoogle ScholarCrossref 41.Scholten
RR , Thijssen
DJH , Lotgering
FK , Hopman
MTE , Spaanderman
MEA . Cardiovascular effects of aerobic exercise training in formerly preeclamptic women and healthy parous control subjects.
Am J Obstet Gynecol. 2014;211(5):516.e1-516.e11. doi:
10.1016/j.ajog.2014.04.025
PubMedGoogle ScholarCrossref 43.Hewage
SS , Wu
S , Neelakantan
N , Yoong
J . Systematic review of effectiveness and cost-effectiveness of lifestyle interventions to improve clinical diabetes outcome measures in women with a history of GDM.
Clin Nutr ESPEN. 2020;35:20-29. doi:
10.1016/j.clnesp.2019.10.011
PubMedGoogle ScholarCrossref 44.Guo
J , Chen
JL , Whittemore
R , Whitaker
E . Postpartum lifestyle interventions to prevent type 2 diabetes among women with history of gestational diabetes: a systematic review of randomized clinical trials.
J Womens Health (Larchmt). 2016;25(1):38-49. doi:
10.1089/jwh.2015.5262
PubMedGoogle ScholarCrossref 45.Goveia
P , Cañon-Montañez
W , Santos
DP ,
et al. Lifestyle intervention for the prevention of diabetes in women with previous gestational diabetes mellitus: a systematic review and meta-analysis.
Front Endocrinol (Lausanne). 2018;9:583. doi:
10.3389/fendo.2018.00583
PubMedGoogle ScholarCrossref 46.Pedersen
ALW , Terkildsen Maindal
H , Juul
L . How to prevent type 2 diabetes in women with previous gestational diabetes? a systematic review of behavioural interventions.
Prim Care Diabetes. 2017;11(5):403-413. doi:
10.1016/j.pcd.2017.05.002
PubMedGoogle ScholarCrossref 47.Gilinsky
AS , Kirk
AF , Hughes
AR , Lindsay
RS . Lifestyle interventions for type 2 diabetes prevention in women with prior gestational diabetes: a systematic review and meta-analysis of behavioural, anthropometric and metabolic outcomes.
Prev Med Rep. 2015;2:448-461. doi:
10.1016/j.pmedr.2015.05.009
PubMedGoogle ScholarCrossref 48.Ratner
RE , Christophi
CA , Metzger
BE ,
et al; Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions.
J Clin Endocrinol Metab. 2008;93(12):4774-4779. doi:
10.1210/jc.2008-0772
PubMedGoogle ScholarCrossref 49.Knowler
WC , Barrett-Connor
E , Fowler
SE ,
et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
N Engl J Med. 2002;346(6):393-403. doi:
10.1056/NEJMoa012512
PubMedGoogle Scholar 50.Aroda
VR , Christophi
CA , Edelstein
SL ,
et al; Diabetes Prevention Program Research Group. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program Outcomes Study 10-year follow-up.
J Clin Endocrinol Metab. 2015;100(4):1646-1653. doi:
10.1210/jc.2014-3761
PubMedGoogle ScholarCrossref 53.Ferrara
A , Hedderson
MM , Brown
SD ,
et al. The comparative effectiveness of diabetes prevention strategies to reduce postpartum weight retention in women with gestational diabetes mellitus: the Gestational Diabetes’ Effects on Moms (GEM) cluster randomized controlled trial.
Diabetes Care. 2016;39(1):65-74. doi:
10.2337/dc15-1254
PubMedGoogle ScholarCrossref 54.Holmes
VA , Draffin
CR , Patterson
CC ,
et al; PAIGE Study Group. Postnatal lifestyle intervention for overweight women with previous gestational diabetes: a randomized controlled trial.
J Clin Endocrinol Metab. 2018;103(7):2478-2487. doi:
10.1210/jc.2017-02654
PubMedGoogle ScholarCrossref 57.Nicklas
JM , Zera
CA , Seely
EW , Abdul-Rahim
ZS , Rudloff
ND , Levkoff
SE . Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes.
BMC Pregnancy Childbirth. 2011;11:23. doi:
10.1186/1471-2393-11-23
PubMedGoogle ScholarCrossref 59.Feng
L , Xu
Q , Hu
Z , Pan
H . Lactation and progression to type 2 diabetes in patients with gestational diabetes mellitus: a systematic review and meta-analysis of cohort studies.
J Diabetes Investig. 2018;9(6):1360-1369. doi:
10.1111/jdi.12838
PubMedGoogle ScholarCrossref 60.Gunderson
EP , Hurston
SR , Ning
X ,
et al; Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy Investigators. Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus—a prospective cohort study.
Ann Intern Med. 2015;163(12):889-898. doi:
10.7326/M15-0807
PubMedGoogle ScholarCrossref 63.Lifestyle intervention for women with recent pre-eclampsia or gestational diabetes mellitus (“Mom's Healthy Heart”). ClinicalTrials.gov identifier: NCT03993145. Updated May 12, 2021. Accessed April 15, 2021.
https://clinicaltrials.gov/ct2/show/NCT03993145 64.Fit After Baby: increasing postpartum weight loss in women at increased risk for cardiometabolic disease (FAB). ClinicalTrials.gov identifier: NCT03215173. Updated March 8, 2021. Accessed April 15, 2021.
https://clinicaltrials.gov/ct2/show/NCT03215173 68.The impact of liraglutide on glucose tolerance and the risk of type 2 diabetes in women with previous pregnancy-induced diabetes. ClinicalTrials.gov identifier: NCT01795248. Updated November 4, 2020. Accessed April 15, 2021.
https://clinicaltrials.gov/ct2/show/NCT01795248 70. ACOG practice bulletin No. 202: gestational hypertension and preeclampsia.
Obstet Gynecol. 2019;133(1):1. doi:10.1097/AOG.0000000000003018
Google Scholar 72.Elkind-Hirsch
KE , Shaler
D , Harris
R . Postpartum treatment with liraglutide in combination with metformin versus metformin monotherapy to improve metabolic status and reduce body weight in overweight/obese women with recent gestational diabetes: a double-blind, randomized, placebo-controlled study.
J Diabetes Complications. 2020;34(4):107548. doi:
10.1016/j.jdiacomp.2020.107548
PubMedGoogle Scholar 73.Elkind-Hirsch
KE , Seidemann
E , Harris
R . A randomized trial of dapagliflozin and metformin, alone and combined, in overweight women after gestational diabetes mellitus.
Am J Obstet Gynecol MFM. 2020;2(3):100139. doi:
10.1016/j.ajogmf.2020.100139
PubMedGoogle Scholar 74.Elkind-Hirsch
KE , Paterson
MS , Shaler
D , Gutowski
HC . Short-term sitagliptin-metformin therapy is more effective than metformin or placebo in prior gestational diabetic women with impaired glucose regulation.
Endocr Pract. 2018;24(4):361-368. doi:
10.4158/EP-2017-0251PubMedGoogle ScholarCrossref 75.Roth
H , LeMarquand
G , Henry
A , Homer
C . Assessing knowledge gaps of women and healthcare providers concerning cardiovascular risk after hypertensive disorders of pregnancy: a scoping review.
Front Cardiovasc Med. 2019;6:178. doi:
10.3389/fcvm.2019.00178
PubMedGoogle ScholarCrossref 77.Sutherland
L , Neale
D , Henderson
J , Clark
J , Levine
D , Bennett
WL . Provider counseling about and risk perception for future chronic disease among women with gestational diabetes and preeclampsia.
J Womens Health (Larchmt). 2020;29(9):1168-1175. doi:
10.1089/jwh.2019.7767
PubMedGoogle ScholarCrossref 78.Marsiglia
FF , Bermudez-Parsai
M , Coonrod
D .
Familias Sanas: an intervention designed to increase rates of postpartum visits among Latinas.
J Health Care Poor Underserved. 2010;21(3)(suppl):119-131. doi:
10.1353/hpu.0.0355
PubMedGoogle Scholar 83.Sharma
G , Zakaria
S , Michos
ED ,
et al. Improving cardiovascular workforce competencies in cardio-obstetrics: current challenges and future directions.
J Am Heart Assoc. 2020;9(12):e015569. doi:
10.1161/JAHA.119.015569
PubMedGoogle Scholar