Importance A growing body of evidence suggests that adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy, gestational diabetes (GD), preterm birth, and intrauterine growth restriction, are associated with increased risk of cardiometabolic disease and cardiovascular disease (CVD) later in life. Adverse pregnancy outcomes may therefore represent an opportunity to intervene to prevent or delay onset of CVD. The objective of this review was to summarize the current evidence for targeted postpartum interventions and strategies to reduce CVD risk in women with a history of APOs.

Observations A search of PubMed and Ovid for English-language randomized clinical trials, cohort studies, descriptive studies, and guidelines published from January 1, 2000, to April 30, 2021, was performed. Four broad categories of interventions were identified: transitional clinics, lifestyle interventions, pharmacotherapy, and patient and clinician education. Observational studies suggest that postpartum transitional clinics identify women who are at elevated risk for CVD and may aid in the transition to longitudinal primary care. Lifestyle interventions to increase physical activity and improve diet quality may help reduce the incidence of type 2 diabetes in women with prior GD; less is known about women with other prior APOs. Metformin hydrochloride may prevent development of type 2 diabetes in women with prior GD. Evidence is lacking in regard to specific pharmacotherapies after other APOs. Cardiovascular guidelines endorse using a history of APOs to refine CVD risk assessment and guide statin prescription for primary prevention in women with intermediate calculated 10-year CVD risk. Research suggests a low level of awareness of the link between APOs and CVD among both patients and clinicians.

Conclusions and Relevance These findings suggest that transitional clinics, lifestyle intervention, targeted pharmacotherapy, and clinician and patient education represent promising strategies for improving postpartum maternal cardiometabolic health in women with APOs; further research is needed to develop and rigorously evaluate these interventions. Future efforts should focus on strategies to increase maternal postpartum follow-up, improve accessibility to interventions across diverse racial and cultural groups, expand awareness of sex-specific CVD risk factors, and define evidence-based precision prevention strategies for this high-risk population.

重要性 越来越多的证据表明，不良妊娠结局 (APO)，包括妊娠期高血压疾病、妊娠糖尿病 (GD)、早产和宫内生长受限，与以后患心脏代谢疾病和心血管疾病 (CVD) 的风险增加有关在生活中。因此，不良妊娠结局可能代表一个干预预防或延迟 CVD 发作的机会。本综述的目的是总结当前有针对性的产后干预措施和策略的证据，以降低有 APO 病史的女性的 CVD 风险。

观察 在 PubMed 和 Ovid 中搜索了 2000 年 1 月 1 日至 2021 年 4 月 30 日期间发布的英语随机临床试验、队列研究、描述性研究和指南。确定了四大类干预措施：过渡性诊所、生活方式干预、药物治疗以及患者和临床医生教育。观察性研究表明，产后过渡诊所可以识别出 CVD 风险较高的女性，并可能有助于过渡到纵向初级保健。增加身体活动和改善饮食质量的生活方式干预可能有助于降低既往 GD 女性的 2 型糖尿病发病率；对之前有其他 APO 的女性知之甚少。盐酸二甲双胍可预防既往患有 GD 的女性发生 2 型糖尿病。其他 APO 后缺乏特定药物治疗的证据。心血管指南支持使用 APOs 的历史来完善 CVD 风险评估，并指导他汀类药物处方用于具有中间计算的 10 年 CVD 风险的女性的一级预防。研究表明，患者和临床医生对 APO 和 CVD 之间联系的认识水平较低。

结论和相关性 这些研究结果表明，过渡性门诊、生活方式干预、靶向药物治疗以及临床医生和患者教育是改善 APO 女性产后母亲心脏代谢健康的有前途的策略；需要进一步研究来制定和严格评估这些干预措施。未来的努力应侧重于增加产妇产后随访的策略，提高不同种族和文化群体对干预措施的可及性，扩大对性别特定 CVD 风险因素的认识，并为这一高危人群制定基于证据的精确预防策略。