Women with a history of gestational diabetes (GDM) or hypertensive disorders of pregnancy (HDP) are at increased long-term risk for cardiovascular disease (CVD). Clinical guidance recommends postpartum screening and preventive care for these women, yet uptake of recommended services is frequently limited. This scoping review aimed to summarize existing evidence on the barriers and facilitators to postpartum CVD screening and prevention services among women with prior GDM or HDP.
The review used a comprehensive search strategy across three databases: Ovid Medline, CINAHL, and Embase. From 18,565 records screened, 29 studies met inclusion criteria and were analyzed. Included studies comprised 12 qualitative and 17 quantitative investigations that explicitly reported barriers or facilitators to postpartum CVD screening and preventive care among women with previous GDM or HDP. The review included studies published in English or French.
The abstract reports the number and general design types of included studies (qualitative and quantitative) but does not provide detailed information in the abstract about geographic distribution, sample sizes, populations, or specific study methodologies. Those details are in the full text and are not summarized in the abstract.
At the individual level, the most frequently identified barriers were lack of knowledge regarding future CVD risk and recommended screening, as well as health- and emotion-related factors. Emotional factors reported included, for example, postpartum stress or competing health concerns. These individual barriers can reduce attendance at follow-up visits and limit engagement with preventive interventions.
Interpersonal barriers most often cited included competing priorities (such as childcare, work, or household responsibilities), lack of family or friend support, and mistrust of healthcare providers. These interpersonal factors influenced women's ability or willingness to seek or maintain follow-up care after a pregnancy complicated by GDM or HDP.
Within healthcare organizations, the most significant barrier identified was gaps in communication. This included failures in transferring information between maternity care and primary care, lack of clear postpartum care plans, or inconsistent messaging about CVD risk and follow-up requirements. Such organizational communication gaps impede effective referral, scheduling, and continuity of preventive services.
At the health-system level, gaps in insurance coverage and related access issues were the most frequently reported barriers. Insurance limitations can restrict access to screening tests, preventive interventions, or primary care follow-up. The abstract highlights insurance coverage as a predominant system barrier but does not enumerate other policy-level factors in detail.
Key individual-level facilitators included a personal desire for better health and the availability of postpartum programmes designed to support screening and prevention. Women motivated to reduce their own risk or to improve long-term health were more likely to engage with recommended services when programmes were accessible.
At the interpersonal level, the review identified women's commitment to modeling a healthy lifestyle for their children as a strong facilitator. Family encouragement and social support also facilitate attendance at follow-up and adoption of preventive behaviors, according to the included studies.
Organizational facilitators reported in the included literature included access to primary care providers, structured follow-up visit reminders, and availability of programmes in women's native languages. These organizational supports can improve continuity of care, increase appointment adherence, and reduce communication barriers related to language.
The scoping review concludes that women with prior GDM or HDP face substantial, multi-level barriers to accessing postpartum CVD prevention services. Barriers span from individual knowledge gaps and emotional or health constraints to interpersonal, organizational, and system-level obstacles such as limited social support, poor communication between providers, and insurance coverage gaps. Facilitators identified include personal motivation, family- and child-centered incentives, access to primary care, reminders, program availability, and language-appropriate services.
Clinicians, health-system planners, and policymakers seeking to improve postpartum CVD prevention uptake should consider interventions that address multiple levels — patient education to close knowledge gaps, enhanced communication and transition planning between maternity and primary care, reminder systems, and policies to address insurance or coverage barriers. Culturally and linguistically appropriate programme design and family-centered approaches may increase engagement among affected women.
The abstract provides study counts and summary thematic findings but does not report quantitative effect sizes, regional distribution of included studies, specific intervention components, or detailed methodological quality assessments. Those details and any study limitations are not reported in the abstract and would require review of the full article for comprehensive appraisal.
The abstract reports that no conflicts of interest were declared by the authors in the source.