Quansah, Dan Yedu

Abstract Aims Although cardiovascular disease (CVD) screening and preventive care in the early postpartum are recommended for women with prior gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP), certain barriers limit access to such services. We conducted a scoping review to summarize evidence on the barriers and facilitators of CVD prevention services among women with prior GDM or HDP. Methods and results A comprehensive search strategy was used to search articles published in three databases (Ovid Medline, CINAHL, Embase). 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, 17 quantitative) were included. Main individual level barriers including lack of knowledge, health, and emotional factors were identified. Competing priorities, lack of family/friend support, and mistrust of healthcare providers were the most reported interpersonal level barriers, while gaps in communication were the most significant organizational barrier, and gaps in insurance coverage was the most reported system barrier. Individual level facilitators included a personal desire for better health and availability of postpartum programmes, and the most reported interpersonal facilitator was women's commitment to modelling a healthy lifestyle for their children. Organizational level facilitators were access to primary care providers and follow-up visit reminders, and programme availability in native languages. Conclusion Women with prior GDM or HDP face significant barriers to accessing postpartum CVD prevention services. These barriers ranged from individual-level knowledge gaps to system-level healthcare disparities.

Introduction Women with previous pregnancy-related cardiovascular risk indicators, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), have an 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 plan to conduct a scoping review of the literature to explore and summarise evidence on the barriers and facilitators of postpartum CVD preventive services in women with a history of GDM and HDP. Methods and analysis This scoping review will be conducted in line with the Arksey and O’Malley’s (2005) methodological framework and the Joanna Briggs Institute guidance for conducting a systematic scoping review and will follow the Evidence for Policy and Practice Information and the Coordinating Centre at the Institute of Education guidelines. The review results will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. We will search the following databases: Medline, Embase and CINAHL. We will conduct grey literature searches for registered dissertations and theses. Inclusion and exclusion criteria will be kept broad. Qualitative and quantitative studies published in English or French that investigated and reported percieved barriers or facilitators to postpartum CVD screening and preventive care among women with previous GDM and HDP will be included. Individual, interpersonal, organizational, and system level factors will be reported. Qualitative findings will be summarised narratively, and quantitative findings will be absorbed within the themes using the multisource synthesis method. Ethics and dissemination This review represents one objective of a larger project that was reviewed by the Ottawa Health Sciences Network Research Ethics Board (QI-184). We will disseminate knowledge emanating from this review through open-access publication, presentation/public forums on women’s cardiovascular health, women’s CVD prevention forums and social media. We will also present the findings of this review at the annual meeting of the Canadian Women’s Heart Health Alliance.