(P232) BARRIERS AND FACILITATORS OF CVD PREVENTION SERVICES FOR WOMEN WITH PRIOR GESTATIONAL DIABETES OR HYPERTENSIVE DISORDERS OF PREGNANCY

Background: Women with previous pregnancy-related cardiovascular risk indicators, including gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP), have increased risk of future cardiovascular disease (CVD). Although CVD screening and preventive care beginning in the early postpartum period are recommended, certain barriers limit access to such services. We conducted a scoping review to explore and summarize evidence on the barriers and facilitators of postpartum CVD preventive services among women with a history of HDP or GDM.

METHODS AND RESULTS: A comprehensive search strategy was used to search articles published in five databases (Ovid Medline, PubMed, CINAHL, PsycINFO, Embase). Qualitative and quantitative studies published in English or French that investigated and reported barriers or facilitators to postpartum CVD screening and preventive care among women with previous GDM and HDP were included.
Out of 18,565 studies we screened, 29 studies (12 qualitative, 16 quantitative, and 1 mixed methods) were included in this review. A total of 23,670 participants were involved in the included studies. Lack of patient awareness and knowledge of CVD risk, mistrust of healthcare provider (HCP), inappropriate timing of postpartum follow-up, childcare priorities, racial disparity, and lack of health insurance were the reported individual barriers to accessing postpartum CVD prevention services. Lack of primary care provider (PCP), trivialization of diagnosis by providers during pregnancy, and appointment scheduling difficulties were identified as provider-level barriers. System level barriers included a lack of postpartum programs, cost of services, and disconnect between care teams. The qualitative studies further revealed competing gender-related responsibilities and stigma attached to screening attendance as societal barriers. Regarding facilitators, desire to improve own health and awareness CVD risks were reported as individual-level factors that enhanced access to care. Follow-up reminders by HCP, use of virtual consultations, and provision of information on CVD risks by HCPs were identified by women as provider level facilitators. None of the studies reported system or societal level factors that enhanced access to preventive services.

Conclusion: This scoping review highlights multiple factors reported by women with prior GDM and HDP that influence access to postpartum preventative care services. Understanding these complexities is crucial for designing targeted interventions and policies that can address the identified barriers while leveraging facilitators to improve risk assessment, diagnosis, and disease management among higher risk postpartum women. Further research and collaborative efforts are needed to bridge gaps and ensure equitable access to quality preventative care during this opportune postpartum period.