Research shows that people who experience hypertensive disorders of pregnancy are at higher risk for heart-related complications in the future. However, patients are not often warned of this risk after delivery.

During pregnancy, blood pressure needs close monitoring. Serious complications from high blood pressure during pregnancy include stroke, preeclampsia and preterm delivery. Hypertensive disorders of pregnancy (HDP) is an umbrella term for blood pressure-related conditions that can happen while pregnant. HDP affects 10% of pregnant patients.  

Doctors used to think that HDP did not carry over to health after delivery. Research now shows that patients who have these conditions while pregnant show higher rates of heart-related problems for decades after giving birth. However, that message may not be getting to patients. 

Do patients know about their risk after pregnancy?

Medical student Mikaela Siegel wondered if doctors were telling their patients with HDP about their increased risk post-delivery. Under the mentorship of a multidisciplinary group of experts – including Johanna Warren, M.D. and Monica Rincon, M.D. MCR. - Siegel set out to find the answer. 

“There is a known association between HDP and future cardiovascular risk,” says Siegel. “What the team wanted to see was: are we telling our patients about this risk?”  

For her research, she defined HDP as including patients with: 

• High blood pressure during pregnancy 
• Chronic high blood pressure 
• Preeclampsia 
• Diabetes during pregnancy 
• Chronic diabetes 
• Blood clots 

Siegel reviewed the records of patients who gave birth at OHSU during a six-month window. She then selected those with any of the concerns listed above. She analyzed what their doctors put in their discharge paperwork about their higher risk of cardiac concerns in the future. 

Room for improvement

Siegel found that: 

• 88% of patients went home from the hospital with paperwork that did not include information about any future cardiac risk. 
• Only 7.9% of patients had paperwork that specifically mentioned their high blood pressure.  

“Essentially, we’re not telling patients about this association in the after visit summary,” says Siegel, “And we often aren’t telling people about a diagnosis they experienced.” 

This leaves a gap that Siegel sees as an opportunity. First, she recognizes providers need to know about the research showing increased risk for HDP patients. She stresses that those who see patients for postpartum follow-up also need to be aware. Second, she suggests starting with the after visit summary as an effective way to convey this information to patients when they leave the hospital. 

“I always agree that this is an opportunity to highlight that transitions of care, especially after you have a baby, can be a really important time for women (and families) to reassess their health,” says Dr. Warren, “It gives them a moment to check back in with a primary care provider (for moms and for kids!) to talk about long-term health goals and healthy habits that will serve them in the future.”  

“You can’t go wrong by telling your patient about this,” says Siegel. “The more we can educate our patients, the more empowered they are.”  

Collaboration and mentorship in medical research projects

Dr. Warren also highlights that this project demonstrates the importance of mentoring medical students. 

“It truly takes an entire medical community to best care for patients AND contribute to educating our future physicians AND contribute to important learnings like this that can improve how we care for patients into the future,” says Warren. “I know that this work will influence how I speak with my patients, and I know it will influence what Mikaela brings to her patients and, importantly, to her future medical community.  The impact of these research projects is greater than we can usually imagine.”