{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:46:31Z","timestamp":1789778791674,"version":"4.0.1"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,7,25]]},"abstract":"Importance<\/jats:title>Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N\u2009=\u2009167\u202f705 [weighted N\u2009=\u20098\u202f714\u202f459]).<\/jats:p><\/jats:sec>Exposures<\/jats:title>Total number of CVD risk factors (0, 1, or \u22652 prepregnancy risk factors or APOs).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year.<\/jats:p><\/jats:sec>Results<\/jats:title>From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, \u22121.4% [95% CI, \u22121.8% to \u22121.0%\/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, \u22120.7% [95% CI, \u22121.3% to \u22120.1%\/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, \u22120.8% [95% CI, \u22121.3% to \u22120.3%\/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2023.11210","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T15:52:44Z","timestamp":1690300364000},"page":"359","source":"Crossref","is-referenced-by-count":31,"title":["Trends in Cardiovascular Health Counseling Among Postpartum Individuals"],"prefix":"10.1001","volume":"330","author":[{"given":"Natalie A.","family":"Cameron","sequence":"first","affiliation":[{"name":"Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigid M.","family":"Dolan","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Greenland","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadiya S.","family":"Khan","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois"},{"name":"Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"key":"joi230074r1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart disease and stroke statistics-2022 update.","author":"Tsao","journal-title":"Circulation"},{"key":"joi230074r3","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.025050","article-title":"Temporal trends in adverse pregnancy outcomes in birthing individuals aged 15 to 44 years in the United States, 2007 to 2019.","author":"Freaney","journal-title":"J Am Heart Assoc"},{"issue":"7","key":"joi230074r4","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1001\/jama.2021.7217","article-title":"Trends in gestational diabetes at first live birth by race and ethnicity in the US, 2011-2019.","volume":"326","author":"Shah","year":"2021","journal-title":"JAMA"},{"key":"joi230074r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpc.2021.100229","article-title":"Trends in prepregnancy cardiovascular health in the United States, 2011-2019.","volume":"7","author":"Wang","year":"2021","journal-title":"Am J Prev Cardiol"},{"issue":"2","key":"joi230074r6","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.023791","article-title":"Trends in the incidence of new-onset hypertensive disorders of pregnancy among rural and urban areas in the United States, 2007 to 2019.","volume":"11","author":"Cameron","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"joi230074r7","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.ahj.2021.08.019","article-title":"Reducing disparities in adverse pregnancy outcomes in the United States.","volume":"242","author":"Shah","year":"2021","journal-title":"Am Heart J"},{"issue":"25","key":"joi230074r8","doi-asserted-by":"publisher","first-page":"e1162","DOI":"10.1161\/CIR.0000000000000638","article-title":"Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease.","volume":"139","author":"Lloyd-Jones","year":"2019","journal-title":"Circulation"},{"issue":"5","key":"joi230074r9","doi-asserted-by":"publisher","first-page":"e140","DOI":"10.1097\/AOG.0000000000002633","article-title":"ACOG committee opinion No. 736: optimizing postpartum care.","volume":"131","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"23","key":"joi230074r10","doi-asserted-by":"publisher","first-page":"2695","DOI":"10.1016\/j.jacc.2020.10.002","article-title":"Associations of late adolescent or young adult cardiovascular health with premature cardiovascular disease and mortality.","volume":"76","author":"Perak","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"17","key":"joi230074r11","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.020717","article-title":"Trends in prepregnancy obesity and association with adverse pregnancy outcomes in the United States, 2013 to 2018.","volume":"10","author":"Wang","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"joi230074r12","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwab121","article-title":"Association of pre-pregnancy cardiovascular risk factor burden with adverse maternal and offspring outcomes.","author":"Wang","journal-title":"Eur J Prev Cardiol"},{"issue":"3","key":"joi230074r13","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1177\/00333549211005814","article-title":"Variation in the content of postpartum visits by maternal race\/ethnicity, preconception, and pregnancy-related cardiovascular disease risk, PRAMS, 2016-2017.","volume":"137","author":"Stanhope","year":"2022","journal-title":"Public Health Rep"},{"issue":"24","key":"joi230074r14","doi-asserted-by":"publisher","first-page":"e843","DOI":"10.1161\/CIR.0000000000000582","article-title":"Promoting risk identification and reduction of cardiovascular disease in women through collaboration with obstetricians and gynecologists.","volume":"137","author":"Brown","year":"2018","journal-title":"Circulation"},{"issue":"15","key":"joi230074r15","doi-asserted-by":"publisher","first-page":"e251","DOI":"10.1161\/CIR.0000000000001000","article-title":"Call to action: maternal health and saving mothers.","volume":"144","author":"Mehta","year":"2021","journal-title":"Circulation"},{"issue":"18","key":"joi230074r16","doi-asserted-by":"publisher","first-page":"e902","DOI":"10.1161\/CIR.0000000000000961","article-title":"Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women.","volume":"143","author":"Parikh","year":"2021","journal-title":"Circulation"},{"issue":"10","key":"joi230074r17","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.2105\/AJPH.2018.304563","article-title":"The Pregnancy Risk Assessment Monitoring System (PRAMS).","volume":"108","author":"Shulman","year":"2018","journal-title":"Am J Public Health"},{"issue":"10","key":"joi230074r19","doi-asserted-by":"publisher","first-page":"e223292","DOI":"10.1001\/jamahealthforum.2022.3292","article-title":"Association of health insurance, geography, and race and ethnicity with disparities in receipt of recommended postpartum care in the US.","volume":"3","author":"Interrante","year":"2022","journal-title":"JAMA Health Forum"},{"issue":"4","key":"joi230074r22","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1161\/HYPERTENSIONAHA.121.16506","article-title":"Long-term cardiovascular disease risk in women after hypertensive disorders of pregnancy.","volume":"78","author":"Khosla","year":"2021","journal-title":"Hypertension"},{"issue":"1","key":"joi230074r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2020.100285","article-title":"Postpartum counseling in women with hypertensive disorders of pregnancy.","volume":"3","author":"Triebwasser","year":"2021","journal-title":"Am J Obstet Gynecol MFM"},{"key":"joi230074r24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpc.2022.100364","article-title":"Knowledge and perception of cardiovascular disease risk in women of reproductive age.","volume":"11","author":"Beussink-Nelson","year":"2022","journal-title":"Am J Prev Cardiol"},{"issue":"2","key":"joi230074r25","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1007\/s10995-021-03232-1","article-title":"Correlates of early prenatal care access among US women: data from the Pregnancy Risk Assessment Monitoring System (PRAMS).","volume":"26","author":"Krukowski","year":"2022","journal-title":"Matern Child Health J"},{"issue":"5","key":"joi230074r26","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1016\/0029-7844(95)00283-W","article-title":"The relationship between diet, activity, and other factors, and postpartum weight change by race.","volume":"86","author":"Boardley","year":"1995","journal-title":"Obstet Gynecol"},{"issue":"2","key":"joi230074r27","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.ogc.2009.04.001","article-title":"Childbearing and obesity in women.","volume":"36","author":"Gunderson","year":"2009","journal-title":"Obstet Gynecol Clin North Am"},{"key":"joi230074r28","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1007\/s10995-016-2044-7","article-title":"Understanding factors associated with postpartum visit attendance and contraception choices: listening to low-income postpartum women and health care providers.","volume":"20","author":"Henderson","year":"2016","journal-title":"Matern Child Health J"},{"issue":"3","key":"joi230074r29","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1001\/jamacardio.2021.4391","article-title":"Interventions to mitigate risk of cardiovascular disease after adverse pregnancy outcomes: a review.","volume":"7","author":"Jowell","year":"2022","journal-title":"JAMA Cardiol"},{"key":"joi230074r30","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001078","article-title":"Life\u2019s essential 8: updating and enhancing the American Heart Association\u2019s construct of cardiovascular health.","author":"Lloyd-Jones","journal-title":"Circulation"},{"issue":"4","key":"joi230074r31","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1111\/hesr.v57.4","article-title":"A systematic review of the qualitative literature on barriers to high-quality prenatal and postpartum care among low-income women.","volume":"57","author":"Bellerose","year":"2022","journal-title":"Health Serv Res"},{"issue":"1","key":"joi230074r32","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1089\/whr.2022.0064","article-title":"Primary care clinician perspectives on patient navigation to improve postpartum care for patients with low income.","volume":"3","author":"Filicko","year":"2022","journal-title":"Womens Health Rep (New Rochelle)"},{"issue":"1","key":"joi230074r33","first-page":"254","article-title":"Provider perspectives on barriers and facilitators to postpartum care for low-income individuals.","volume":"2","author":"Ruderman","year":"2021","journal-title":"Womens Health Rep (New Rochelle)"},{"issue":"6","key":"joi230074r34","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1097\/AOG.0000000000000856","article-title":"Recognition by women\u2019s health care providers of long-term cardiovascular disease risk after preeclampsia.","volume":"125","author":"Wilkins-Haug","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"2","key":"joi230074r35","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s40119-021-00220-y","article-title":"Variations in awareness of association between adverse pregnancy outcomes and cardiovascular risk by specialty.","volume":"10","author":"Gogineni","year":"2021","journal-title":"Cardiol Ther"},{"key":"joi230074r36","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1146\/publhealth.2019.40.issue-1","article-title":"The digitization of patient care: a review of the effects of electronic health records on health care quality and utilization.","volume":"40","author":"Atasoy","year":"2019","journal-title":"Annu Rev Public Health"},{"issue":"3","key":"joi230074r37","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1097\/AOG.0000000000000420","article-title":"A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial.","volume":"124","author":"Nicklas","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"20","key":"joi230074r38","doi-asserted-by":"publisher","first-page":"2069","DOI":"10.1001\/jama.2020.21749","article-title":"Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors.","volume":"324","author":"Krist","year":"2020","journal-title":"JAMA"},{"issue":"10","key":"joi230074r40","doi-asserted-by":"publisher","first-page":"2489","DOI":"10.1007\/s10995-014-1487-y","article-title":"Validation of self-reported maternal and infant health indicators in the Pregnancy Risk Assessment Monitoring System.","volume":"18","author":"Dietz","year":"2014","journal-title":"Matern Child Health J"},{"issue":"1","key":"joi230074r41","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1177\/003335491513000108","article-title":"Validation of selected items on the 2003 US standard certificate of live birth: New York City and Vermont.","volume":"130","author":"Dietz","year":"2015","journal-title":"Public Health Rep"},{"issue":"1","key":"joi230074r42","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1097\/EDE.0000000000000936","article-title":"Quality of maternal height and weight data from the revised birth certificate and pregnancy risk assessment monitoring system.","volume":"30","author":"Deputy","year":"2019","journal-title":"Epidemiology"},{"key":"joi230074r2","doi-asserted-by":"crossref","DOI":"10.15620\/cdc:118018","volume-title":"Trends and Characteristics in Gestational Diabetes: United States, 2016\u20132020","author":"Gregory","year":"2022"},{"key":"joi230074r18","unstructured":"Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute. Joinpoint regression program. Accessed May, 25, 2023.? https:\/\/surveillance.cancer.gov\/joinpoint\/"},{"key":"joi230074r20","unstructured":"Centers for Disease Control and Prevention. Pregnancy Risk Assessment Monitoring System Methodology. Published March 28, 2023. Accessed May 28, 2023.? https:\/\/www.cdc.gov\/prams\/methodology.htm"},{"key":"joi230074r21","doi-asserted-by":"crossref","unstructured":"Stata Corp LP. Stata Statistical Software version 14. Accessed July 26, 2021.? https:\/\/www.stata.com\/stata14\/","DOI":"10.4324\/9781003149286-3"},{"key":"joi230074r39","unstructured":"National Institutes of Health; Health Resources and Services Administration; Administration for Children and Families. RFA-HL-22-008: Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH) Multisite Resource and Coordinating Center (U24 Clinical Trial Required). Accessed April 21, 2022. https:\/\/grants.nih.gov\/grants\/guide\/rfa-files\/RFA-HL-22-008.html"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2807566\/jama_cameron_2023_oi_230074_1689353558.68628.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T15:52:51Z","timestamp":1690300371000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2807566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,25]]},"references-count":42,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,7,25]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2023.11210","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2023,7,25]]}}}