What Is My Risk? A Mixed‐Methods Systematic Review of Risk Perception for Cardiometabolic Pregnancy Complications and Future Cardiometabolic Disease Development

INTRODUCTION: Cardiometabolic pregnancy complications increase future cardiometabolic disease risk. Accurate risk perception plays a central role in adopting risk-reducing lifestyle and health-related behaviors, such as healthy eating, physical activity, and weight management. This review aimed to explore high-risk pregnant and postpartum women's perception of their risk of developing cardiometabolic pregnancy complications or future cardiometabolic disease. METHODS: Systematic search identified quantitative and qualitative data exploring risk perception in women (pregnant/postpartum) at risk of or diagnosed with gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR), and preterm birth (PTB). A convergent integrated mixed-methods synthesis was undertaken, with findings interpreted using the health belief and capability, opportunity, and motivation for behavior change models. RESULTS: Overall, 84 studies were included, with the majority in GDM (77.4%) and HDP (23.8%), with limited research in PTB (8.3%) and IUGR (6.0%). Women had low-moderate knowledge of pregnancy complications as risk factors for future cardiometabolic disease and low-moderate perceived susceptibility to potential pregnancy complications and future cardiometabolic disease. Self-perceived barriers, facilitators, cues to action, self-efficacy, and self-optimism impacted engagement with lifestyle and screening measures. The highest risk perception for future type 2 diabetes or cardiovascular disease was among women who had previously experienced GDM or HDP, respectively. CONCLUSION: Designing interventions to optimize women's risk perception will support informed decision-making and empower women to make lifestyle changes to reduce future cardiometabolic risk.