Prevention and Screening for Cardiometabolic Disease Following Hypertensive Disorders in Pregnancy in Low-Resource Settings: A Systematic Review and Delphi Study
Date
2023
Journal Title
Journal ISSN
Volume Title
Publisher
Global Heart
Abstract
Hypertensive disorders in pregnancy (HDP) and cardiometabolic and kidney diseases
are rising in low- and middle-income countries (LMICs). While HDP are risk factors for
cardiometabolic and kidney diseases, cost-effective, scalable strategies for screening
and prevention in women with a history of HDP are lacking. Existing guidelines
and recommendations require adaptation to LMIC settings. This article aims to
generate consensus-based recommendations for the prevention and screening of
cardiometabolic and kidney diseases tailored for implementation in LMICs.
We conducted a systematic review of guidelines and recommendations for prevention
and screening strategies for cardiometabolic and chronic kidney diseases following
HDP. We searched PubMed/Medline, Embase and Cochrane Library for relevant articles
and guidelines published from 2010 to 2021 from both high-income countries (HICs)
and LMICs. No other filters were applied. References of included articles were also
assessed for eligibility. Findings were synthesized narratively. The summary of guiding
recommendations was subjected to two rounds of Delphi consensus surveys with
experts experienced in LMIC settings.
Fifty-four articles and 9 guidelines were identified, of which 25 were included. Thirty-five
clinical recommendations were synthesized from these and classified into six domains:
identification of women with HDP (4 recommendations), timing of first counseling and
provision of health education (2 recommendations), structure and care setting (12
recommendations), information and communication needs (5 recommendations),
cardiometabolic biomarkers (8 recommendations) and biomarkers thresholds (4
recommendations). The Delphi panel reached consensus on 33 final recommendations.
These recommendations for health workers in LMICs provide practical and scalable
approaches for effective screening and prevention of cardiometabolic disease following
HDP. Monitoring and evaluation of implementation of these recommendations
provide opportunities for reducing the escalating burden of noncommunicable
diseases in LMICs.
Description
Research Article
Keywords
Hypertensive disorders in pregnancy, risks of future cardiometabolic diseases, prevention and screening strategies
Citation
Ishaku SM, Adu-Bonsaffoh K, Housseine N, Lamptey R, Franx A, Grobbee D, Warren CE, Browne JL. Prevention and Screening for Cardiometabolic Disease Following Hypertensive Disorders in Pregnancy in Low-Resource Settings: A Systematic Review and Delphi Study. Global Heart. 2023; 18(1): 21. DOI: https:// doi.org/10.5334/gh.1195