Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy (2026)
Chapter: Appendix A: Affordable Care Act—Covered Clinical Preventive Services
Appendix A
Affordable Care Act–Covered Clinical Preventive Services
This appendix summarizes Affordable Care Act (ACA)–covered clinical preventive services recommended by the U.S. Preventive Services Task Force (USPSTF), the Women’s Preventive Services Initiative (WPSI), and Bright Futures that are relevant to cardiovascular health in pregnancy and the postpartum period. The table outlines the target population, recommendation statement, and grade or strength (where applicable).
USPSTF and WPSI recommendations primarily address adult populations, whereas Bright Futures focuses on children and adolescents (generally through age 21) and is not designed specifically for pregnant or postpartum populations. Bright Futures recommendations are included here to highlight opportunities for earlier-life prevention that may influence cardiovascular risk in pregnancy and beyond. Only Bright Futures universal recommendations (those applying to all individuals within an age group) are shown; selective recommendations that apply only on the basis of individual risk factors are not included.
Table A-1 is organized into two sections: (1) services most directly related to cardiovascular/cardiometabolic risk and (2) other relevant preventive services (e.g., behavioral health, breastfeeding support, and enabling services). USPSTF I statements and D recommendations are included to provide context and highlight evidence gaps.
Terminology in this appendix reflects the language in the cited guidelines and recommendations. In some cases, it differs from that used by the committee elsewhere in the report.
TABLE A-1 Affordable Care Act–Covered Clinical Preventive Services Relevant to Cardiovascular Disease and Pregnancy
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| SECTION 1. Preventive services most directly relevant to cardiovascular/cardiometabolic health | |||
| Adolescents | |||
| Blood pressure | Screening | Bright Futures (Hagan et al., 2017) | BP screening routinely at well-child visits beginning at age 3 through adolescence (through age 21) |
| USPSTF (USPSTF, 2020b) | Evidence insufficient to assess the balance of benefits and harms of screening for high BP in children and adolescents <18 years (I statement) | ||
| BMI/obesity | Screening; counseling/interventions | Bright Futures (Hagan et al., 2017) | Measuring and plotting BMI at well-child visits |
| USPSTF (USPSTF, 2024) | Providing or referring children and adolescents ≥6 years with a high BMI (≥95th percentile) to comprehensive, intensive behavioral interventions (B) | ||
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| Lipid disorders | Screening | Bright Futures (Hagan et al., 2017) | Lipid screening once aged 9–11 and once 17–21 |
| USPSTF (USPSTF, 2023d) | Evidence insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents ≤20 years (I statement) | ||
| Tobacco/nicotine use | Prevention counseling/education; screening/assessment | Bright Futures (Hagan et al., 2017) | Screening for tobacco use at ages 12, 15, and 18–21 |
| USPSTF (USPSTF, 2020d) | Primary care clinicians provide interventions (including education or brief counseling) to prevent initiation of tobacco use among school-aged children and adolescents (B) Update in progress for this topic | ||
| Prediabetes and TDM (children/adolescents) | Screening | USPSTF (USPSTF, 2022e) | Evidence insufficient to assess the balance of benefits and harms of screening for TDM in children and adolescents (I statement) |
| Pregnancy/postpartum | |||
| HDPs (including PE) | Screening | USPSTF (USPSTF, 2023c) | Screening for hypertensive disorders in pregnant patients with BP measurements throughout pregnancy (B) |
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| GDM and PP diabetes screening after GDM | Screening | USPSTF (USPSTF, 2021c) | Screening for GDM in asymptomatic pregnant persons at ≥24 weeks’ gestation (B) Evidence insufficient for screening before 24 weeks’ gestation (I statement) |
| WPSI (WPSI, 2024b,e) | Screening at after 24 weeks’ gestation (preferably 24–28 weeks) and screening pregnant women with risk factors for TDM or GDM before 24 weeks’ gestation—ideally at the first PN visit PP screening for TDM in women with a history of GDM within the first year PP (as early as 4–6 weeks); women not screened in the first year PP or with a negative initial PP screening test should be screened at least every 3 years for a minimum of 10 years after pregnancy; for those with a positive screening test result in the early PP period, repeat testing ≥6 months PP to confirm early positive results |
||
| Prevent PE and related morbidity/mortality (low-dose aspirin) | Preventive medication | USPSTF (USPSTF, 2021a) | Low-dose aspirin (81 mg/day) as preventive medication after 12 weeks’ gestation in persons at high risk for PE (B) |
| Healthy gestational weight gain | Counseling | USPSTF (USPSTF, 2021d) | Clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy (B) |
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| Tobacco smoking cessation (pregnancy) | Counseling; preventive medication | USPSTF (USPSTF, 2021g) | Clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation (A) Topic being updated |
| Adults (includes women of reproductive age and those who may become pregnant) | |||
| HTN (adults) | Screening | USPSTF (USPSTF, 2021e) | Screening adults ≥18 years without known HTN with office BP measurement and obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment (A) |
| Prediabetes and TDM (adults) | Screening | USPSTF (USPSTF, 2021f) | Screening adults aged 35–70 years who have overweight or obesity for prediabetes and TDM; clinicians should offer or refer patients with prediabetes to effective preventive interventions (B) |
| Tobacco smoking cessation (nonpregnant adults) | Counseling; preventive medication | USPSTF (USPSTF, 2021g) | Clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation (A) |
| Obesity/weight management | Counseling/interventions | USPSTF (USPSTF, 2018e) | Clinicians offer or refer adults with BMI ≥30 to intensive, multicomponent behavioral interventions (B) Topic being updated |
| WPSI (WPSI, 2024c) | Counseling midlife women aged 40–60 with normal or overweight BMI to maintain weight or limit weight gain to prevent obesity | ||
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| Healthy diet and physical activity counseling for CVD prevention (adults with CVD risk factors) | Counseling | USPSTF (USPSTF, 2020a) | Offering or referring adults with CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. (B) Update in progress for a related topic: Healthy Diet, Physical Activity, and/or Weight Loss to Prevent CVD in Adults |
| Vitamin, mineral, and multivitamin supplementation to prevent CVD and cancer (nonpregnant adults) | Preventive medication | USPSTF (USPSTF, 2022g) | Recommends against the use of beta carotene or vitamin E supplements for the prevention of CVD or cancer (D) Evidence insufficient to assess the balance of benefits and harms of multivitamin supplementation for prevention of CVD or cancer (I statement) |
| Asymptomatic carotid artery stenosis | Screening | USPSTF (USPSTF, 2021b) | Recommends against screening for asymptomatic carotid artery stenosis in the general adult population (D) |
| PAD and CVD risk assessment with ABI | Screening | USPSTF (USPSTF, 2018c) | Evidence insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk with the ABI in asymptomatic adults (I statement) |
| CVD risk: screening EKG | Screening | USPSTF (USPSTF, 2018a) | Recommends against screening with resting or exercise EKG to prevent CVD events in asymptomatic adults at low risk of CVD events (D) Evidence insufficient for screening with EKG in asymptomatic adults at intermediate or high risk of CVD events (I statement) |
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| Enhanced CVD risk assessment (nontraditional risk factors) | Risk assessment | USPSTF (USPSTF, 2018b) | Evidence insufficient to assess the balance of benefits and harms of adding the ABI, high-sensitivity hsCRP, or CAC score to traditional risk assessment in asymptomatic adults to prevent CVD events (I statement) Recommendation update in progress focused on CAC scoring |
| SECTION 2. Other preventive services relevant to CVD and pregnancy (indirect/enabling, behavioral health, and context) | |||
| Adolescents | |||
| Alcohol and drug use | Screening; counseling | Bright Futures (CRAFFT, 2025; Hagan et al., 2017) | Screening for alcohol or drug use at ages 12, 15, and 18–21; CRAFFT as a screening tool |
| USPSTF (USPSTF, 2018d, 2020c) | Evidence insufficient to assess the balance of benefits and harms of screening and brief behavioral counseling interventions for alcohol use in primary care settings in adolescents aged 12–17 (I statement) Topic being updated Evidence insufficient to assess the balance of benefits and harms of primary care–based behavioral counseling interventions to prevent illicit drug use (including nonmedical use of prescription drugs) in children, adolescents, and young adults (I statement) |
||
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| Depression | Screening | Bright Futures (Cheung, 2018; Hagan et al., 2017) | Depression (and suicide risk) screening for adolescents beginning at age 12 |
| USPSTF (USPSTF, 2022c) | Screening for major depressive disorder in adolescents aged 12–18; should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up (B) | ||
| Anxiety | Screening | USPSTF (USPSTF, 2022a) | Screening for anxiety in children and adolescents aged 8–18 (B) Evidence insufficient for screening for anxiety in children ≤7 (I statement) |
| Pregnancy/postpartum | |||
| Depression and suicide risk | Screening | USPSTF (USPSTF, 2023b) | Screening for depression in the adult population, including pregnant and PP persons and older adults (B) Evidence insufficient to assess the balance of benefits and harms of screening for suicide risk in the adult population, including pregnant and PP persons and older adults (I statement) |
| Anxiety | Screening | USPSTF (USPSTF, 2023a) | Screening for anxiety disorders in adults, including pregnant and PP persons (B) |
| WPSI (WPSI, 2024d) | Screening for anxiety in adolescent and adult women, including those who are pregnant or PP; optimal screening intervals unknown | ||
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| Unhealthy alcohol use | Screening; counseling | USPSTF (USPSTF, 2018d) | Screening for unhealthy alcohol use in primary care settings in adults ≥18 years, including pregnant women, and providing brief behavioral counseling interventions to persons engaged in risky or hazardous drinking (B) Topic being updated |
| Breastfeeding support | Counseling/support | USPSTF (USPSTF, 2025a) | Providing interventions or referrals, during pregnancy and after birth, to support breastfeeding (B) |
| WPSI (WPSI, 2022) | Comprehensive lactation support services (including consultation, counseling, education by peer support services, and breastfeeding equipment and supplies) during the antenatal, perinatal, and PP periods | ||
| Perinatal depression prevention/maternal depression screening | Counseling; preventive interventions; screening | Bright Futures (Hagan et al., 2017) | Screening for maternal depression at PN and infant well visits (i.e., 1, 2, 4, and 6 months) |
| USPSTF (USPSTF, 2019) | Clinicians provide or refer pregnant and PP persons who are at increased risk of perinatal depression to counseling interventions (B) Topic being updated | ||
| Women specific | |||
| Well-woman preventive visits | Preventive visit (coordination/delivery) | WPSI (WPSI, 2024f) | Women receive at least one preventive care visit per year beginning in adolescence and continuing across the lifespan to ensure the provision of all recommended preventive services; well-women visits include prepregnancy, prenatal, PP, and interpregnancy |
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| Contraception and contraceptive care | Counseling; access to preventive services | WPSI (WPSI, 2024a) | Adolescent and adult women have access to the full range of FDA-approved, -granted, or -cleared contraceptives and contraceptive care (screening, education, counseling, provision—including immediate PP—and follow-up) |
| Adults (includes women of reproductive age and those who may become pregnant) | |||
| Healthy diet and physical activity counseling (adults without CVD risk factors) | Counseling | USPSTF (USPSTF, 2022d) | Clinicians individualize the decision to offer or refer adults without known CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity (C) Topic being updated |
| Aspirin use to prevent CVD (primary prevention) | Preventive medication | USPSTF (USPSTF, 2022b) | For adults aged 40–59 with an estimated ≥10% 10-year CVD risk, the decision to initiate low-dose aspirin for primary prevention should be an individual one; net benefit is small (C) |
| Statin use to prevent CVD (primary prevention) | Preventive medication | USPSTF (USPSTF, 2022f) | Clinicians prescribe a statin for the primary prevention of CVD for adults aged 40–75 with ≥1 CVD risk factor and an estimated 10-year CVD risk ≥10% (B) Clinicians selectively offer a statin for the primary prevention of CVD for adults aged 40–75 with ≥1 CVD risk factor and 10-year risk 7.5–<10% (C) |
| Unhealthy drug use | Screening | USPSTF (USPSTF, 2020e) | Screening by asking questions about unhealthy drug use in adults aged ≥18 (including pregnant and PP persons) when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred (B) |
| Topic | Type | Organization | Recommendation (grade/strength, where applicable) |
|---|---|---|---|
| Food insecurity | Screening | USPSTF (USPSTF, 2025b) | Evidence insufficient to assess the balance of benefits and harms of screening for food insecurity on health outcomes in the primary care setting (I statement) |
NOTES: Evidence grades in parentheses reflect USPSTF letter grades, which indicate the task force’s assessment of certainty and net benefit: A = high certainty of substantial net benefit; B = high certainty of moderate net benefit or moderate certainty of moderate to substantial net benefit; C = at least moderate certainty that the net benefit is small (selectively offer based on professional judgment and patient preferences); D = moderate or high certainty of no net benefit or that harms outweigh benefits (recommend against); I = insufficient evidence to assess the balance of benefits and harms. Bright Futures and WPSI recommendations do not use the USPSTF letter-grade system unless otherwise noted. ACA = Affordable Care Act; ABI = ankle-brachial index; BMI = body mass index; CAC = coronary artery calcium; CRAFFT = Car, Relax, Alone, Forget, Friends, Trouble (substance use screening tool); CVD = cardiovascular disease; EKG = electrocardiogram; FDA = U.S. Food and Drug Administration; GDM = gestational diabetes mellitus; HDP = hypertensive disorder of pregnancy; hsCRP = high-sensitivity C-reactive protein; HTN = hypertension; PAD = peripheral artery disease; PE = preeclampsia; PN = prenatal; PP = postpartum; TDM = type 2 diabetes mellitus; USPSTF = U.S. Preventive Services Task Force; WPSI = Women’s Preventive Services Initiative.
SOURCES: Cheung, 2018; CRAFFT, 2025; Hagan et al., 2017; USPSTF, 2018a,b,c,d,e, 2019, 2020a,b,c,d,e, 2021a,b,c,d,e,f,g, 2022a,b,c,d,e,f,g, 2023a,b,c,d, 2024, 2025a,b; WPSI, 2022, 2024a,b,c,d,e,f.
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