In this study we aimed to assess the knowledge of obstetrician-gynecologists in outpatient settings in the public state of Lower Saxony (7.9 Mill. residents in 2012) of the association between PE and future health risk, e.g. the association with renal diseases, stroke and hypertension and the knowledge of the current German guidelines for the treatment and follow-up of women that experienced PE in pregnancy.
Our results suggest that those physicians that answered the survey have a good knowledge about the association between PE and the development of vascular diseases later in life. Although most respondents (86.6%) were aware of the association between PE and future CVD, only 45.2% knew the current guidelines for the long-term treatment and counseling of women with PE. Time of profession and mean age of patients that were treated in the outpatient clinic had no influence on that knowledge. Nearly all respondents included PE as part of their medical history and counseled on the elevated risk for the development of CVD and kidney disease.
Large cohort studies confirm the association of PE with future CVD, stroke and kidney disease later in life although the pathophysiology of PE is still not fully understood.
While the national guideline for the prevention of CVD includes smoking, malnutrition and overweight, hypertension, genetic factors and lipid metabolism disorder as risk factors for the development of future CVD, it does not address the association between PE and future CVD .
To our knowledge only a few studies have looked into awareness and knowledge of physicians on long-term health risks after PE, long-term treatment after PE and the knowledge of current national guidelines. Macdonald et al. evaluated the communication between maternity care providers in Ontario and the knowledge about the association between PE and the elevated risk for the development of CVD later in life. In that study only 54.0% of respondents were familiar with the increased risk of CVD after PE .
Brett et al. also noted in their study that there was a limited knowledge of the association between PE and future CVD . Most specialists in internal medicine (95.0%) and gynecology (70.0%) provided routine counseling on cardiovascular risk-reduction, but a substantial proportion of them were unaware of any association with a history of PE. About half of the participating internists were not sure or did not know about the association of PE with CVD (56.0%), stroke (48.0%) and decreased life expectancy. Compared to that 23.0% of the gynecologists had lack of knowledge of the risk of the development of CVD, 38.0% were unsure about the stroke risk and 77.0% were unaware of the decreased life expectancy. Of all gynecologists 38.0% were providing cardiovascular risk reduction counseling on women with a history of PE compared to 9.0% of internists in that study.
Our study has a few limitations. Because only some half of the physicians approached, took part in this study, it is unknown whether the knowledge of the non-respondents is comparably good. Furthermore, respondents´ answers may have been influenced by how they suspected the authors wanted them to answer, and if this did occur, the level of knowledge demonstrated here might be artificially high. Due to low numbers in some of the four answer categories we had to group the positive and negative results to be able to perform statistical analysis. This might have caused imprecision and precluded us from a more refined analysis.
Adequate risk reduction counseling can only occur if physicians are aware of the association between PE and long-term health risks and the knowledge of current guidelines. In our study 96.2% of participants indicated an interest in further training. These data suggest appropriate offers for continuing education are necessary and should be established.