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Ogunwole SM, Chen X, Mitta S, Minhas A, Sharma G, Zakaria S, Vaught AJ, Toth-Manikowski SM, Smith G. Interconception Care for Primary Care Providers: Consensus Recommendations on Preconception and Postpartum Management of Reproductive-Age Patients With Medical Comorbidities. Mayo Clin Proc Innov Qual Outcomes 2021; 5:872-890. [PMID: 34585084 PMCID: PMC8452893 DOI: 10.1016/j.mayocpiqo.2021.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Severe maternal morbidity and mortality continue to increase in the United States, largely owing to chronic and newly diagnosed medical comorbidities. Interconception care, or care and management of medical conditions between pregnancies, can improve chronic disease control before, during, and after pregnancy. It is a crucial and time-sensitive intervention that can decrease maternal morbidity and mortality and improve overall health. Despite these potential benefits, interconception care has not been well implemented by the primary care community. Furthermore, there is a lack of guidelines for optimizing preconception chronic disease, risk stratifying postpartum chronic diseases, and recommending general collaborative management principles for reproductive-age patients in the period between pregnancies. As a result, many primary care providers, especially those without obstetric training, are unclear about their specific role in interconception care and may be unsure of effective methods for collaborating with obstetric care providers. In particular, internal medicine physicians, the largest group of primary care physicians, may lack sufficient clinical exposure to medical conditions in the obstetric population during their residency training and may feel uncomfortable in caring for these patients in their subsequent practice. The objective of this article is to review concepts around interconception care, focusing specifically on preconception care for patients with chronic medical conditions (eg, chronic hypertension, chronic diabetes mellitus, chronic kidney disease, venous thromboembolism, and obesity) and postpartum care for those with medically complicated pregnancies (eg, hypertensive disorders of pregnancy, gestational diabetes mellitus, excessive gestational weight gain, peripartum cardiomyopathy, and peripartum mood disorders). We also provide a pragmatic checklist for preconception and postpartum management.
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Key Words
- ACE, angiotensin-converting enzyme
- ACOG, American College of Obstetricians and Gynecologists
- ARB, angiotensin receptor blocker
- BMI, body mass index
- CKD, chronic kidney disease
- CVD, cardiovascular disease
- DM, diabetes mellitus
- GDM, gestational diabetes mellitus
- HDP, hypertensive disorder of pregnancy
- HbA1c, hemoglobin A1c
- MFM, maternal-fetal medicine
- NTD, neural tube defect
- OB/GYN, obstetrician/gynecologist
- PCP, primary care provider
- PPCM, peripartum cardiomyopathy
- SMFM, Society for Maternal-Fetal Medicine
- VTE, venous thromboembolism
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Affiliation(s)
- S Michelle Ogunwole
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xiaolei Chen
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Srilakshmi Mitta
- Division of Obstetric and Consultative Medicine, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Anum Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arthur Jason Vaught
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephanie M Toth-Manikowski
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago
| | - Graeme Smith
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Queens University School of Medicine, Kingston, Ontario, Canada
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