Addressing cardiovascular risk after adverse pregnancy outcomes: a health equity-focused qualitative review.

Abstract

Cardiovascular disease (CVD) risk increases following adverse pregnancy outcomes (APOs) including hypertensive disorders of pregnancy (HDP), preterm labour, and foetal growth restriction. APOs disproportionately affect women of certain ethnic minorities and those who are socio-economically deprived. Risk of CVD after APOs is approximately doubled and two-thirds of women experiencing pre-eclampsia die prematurely from CVD. This review examines women's perspectives on postnatal lifestyle interventions to address long-term CVD risk, focusing on highest-risk groups. Qualitative systematic review and thematic synthesis. A protocol was registered on PROSPERO (CRD420250654735). Papers were included if they contained qualitative components reporting views on addressing CVD risk in women experiencing APOs. Of 1887 screened articles 33% of included papers demonstrated recruitment of an ethnically diverse participant group, 39% demonstrated diversity of socioeconomic status. Themes from the synthesis were 1) pregnancy is a motivator for lifestyle change but many barriers exist, including lack of physical and psychological recovery and guilt at self-prioritisation, and 2) women felt abandoned, seeing a contrast between highly monitored pregnancies and inadequate post-partum care. They desire structured post-partum follow-up with formal recalls, those from higher risk groups are particularly unlikely to seek follow-up independently. We will run a series of community-based workshops with minority ethnic groups in early 2026. Workshops will be co-facilitated by community link workers. Review findings will be presented and future research priorities will be identified. Findings of both the qualitative evidence synthesis and community-based workshops will be presented at conference.