Postpartum cardiovascular risk screening
At 6 months postpartum, all women underwent physical and biochemical CVR
screening in the Maternal Health Clinic (Kingston General Hospital) or
at The Ottawa Hospital (Ottawa) according to published
protocol.28 A full medical history was taken and
included information on family history, breastfeeding and lifestyle such
as smoking status and alcohol intake. A physical examination,
specifically focusing on cardiovascular-related clinical predictors, was
performed and collected information on weight, height, and blood
pressure. A maternal blood sample was collected and total cholesterol,
LDL cholesterol, HDL cholesterol, triglycerides, glucose and C-reactive
protein were quantified for each participant. A random urine sample was
collected and the albumin:creatinine ratio was measured. Physical and
biochemical CVR findings were integrated to calculate a lifetime risk
score for CVD, according to the previously published
protocol.28 Calculations for lifetime cardiovascular
risk are based on the following risk factors: total cholesterol,
systolic blood pressure, diastolic blood pressure, use of
antihypertensive medication(s), fasting blood glucose, diagnosis of
diabetes and current smoking status. Risk stratification for each risk
factor was based on predetermined measurement thresholds (optimal, not
optimal, elevated, major). Lifetime cardiovascular risk estimates are
also categorical and based on the total number of optimal, not optimal,
elevated and major risk factors of each individual (8%, all risk
factors are optimal; 27%, ≥1 risk factor is not optimal; 39%, ≥1 risk
factor is elevated; 39%, 1 risk factor is major; 50%, ≥2 risk factors
are major). Lifetime cardiovascular risk estimates were simplified to
categorize woman as low risk (<39% risk) or high risk (≥39%
risk) for lifetime CVD. This threshold corresponds to the baseline
lifetime CVD risk attributed to healthy women enrolled in the Framingham
Heart Study.34