Health care issues during COVID-19 may worsen pregnancy, chronic disease-related inequities

Pregnancy complications affect up to one in three pregnancies and are increasingly linked to future chronic disease. For example, preeclampsia is associated with a doubled risk of cardiovascular disease, the leading cause of death in the U.S., and gestational diabetes is associated with a seven-fold increased risk of type 2 diabetes. While guidelines recommend preventive care starting within the first postpartum year to address such pregnancy-related health risks, the connections between pregnancy health and future health are often neglected.

In a Viewpoint in the Journal of General Internal Medicine, researchers warn that health care delivery and access issues related to the COVID-19 pandemic may worsen pregnancy and chronic disease-related inequities.

"Missed opportunities to address pregnancy-related chronic disease risk not only threaten individuals' wellbeing; they perpetuate long-term health inequities," said corresponding author Mara Murray Horwitz, MD, assistant professor medicine, section of general internal medicine at Boston University School of Medicine.

Murray Horwitz argues that if pregnancy-related chronic disease risk management does not improve, the current pandemic may create a future pandemic of preventable chronic diseases. She discusses major challenges and potential solutions to pregnancy-related chronic disease risk management in primary care, taking into account new challenges and opportunities during the COVID-19 era. She highlights the need for innovations in care coordination and health care delivery, including virtual medicine and self-monitoring tools. She also discusses a necessary shift in the perceived role of primary care clinicians in postpartum care.

According to Murray Horwitz, the current health care system excels at taking care of specific problems, looking after individual organ systems or delivering care during discrete periods of time.

However, a person's health is not neatly divided into problems, organ systems or periods of time; it is interconnected and extends across the life-course. The connections between pregnancy health and long-term health are just one example of the need for holistic, integrated, and long-term approaches to health promotion."

Murray Horwitz, Physician, Boston Medical Center