New guidelines to improve maternal cardiovascular health before, during and after pregnancy
Thanks largely to the efforts of researchers at Johns Hopkins Medicine, the American Heart Association (AHA) recently published recommendations for improving cardiovascular health outcomes in women before, during, and after pregnancy. According to the U.S. Centers for Disease Control and Prevention (CDC), the United States has the highest maternal mortality rate among developed countries, with an estimated 700 deaths per year from pregnancy complications.
In addition, the AHA reports that heart disease and stroke contribute to one in three of these deaths, primarily from cardiomyopathy (in which the heart loses its ability to pump blood effectively), cerebrovascular disease (conditions that affect blood flow to the brain), or other cardiovascular disorders. For non-Hispanic black and Alaskan Native American / indigenous women, it is nearly two to three times higher than the rate for white women.
To raise awareness of the problem and address it medically, an AHA working group co-led by cardiologist Garima Sharma, MD, director of the cardio-obstetric program at the Johns Hopkins University School of Medicine, created the new guidelines published in a policy statement entitled “Call to Action: Maternal Health and Saving Mothers,” which was posted online in the AHA Journal on September 8, 2021 traffic.
The guidelines, Sharma said, also address the inequalities that hinder adequate maternal health care for all.
Regardless of occupation, place of residence, race or social status, a woman deserves a health system that, as a healthy mother, ensures a healthy pregnancy, childbirth and beyond. With concerted efforts, the United States can save maternal lives by implementing simple changes in our patient and provider approach and system overhauls to meet the needs of women in their reproductive years. “
Garima Sharma, MD, director of the cardio-obstetric program, Johns Hopkins University School of Medicine
In their statement, Sharma and her AHA colleagues outline the inequalities that influence disparities and suggest approaches to improve maternal outcomes. Sharma says the guidelines serve as a roadmap for policy makers and health care leaders to respond to the problem.
“Science is driven by patient advocacy and cannot affect women’s daily lives until policies change,” Sharma said. “This statement brings together the science from decades of data and translates that science into actionable elements that could make real changes that could ultimately save women’s lives.”
According to the World Health Organization, the global maternal mortality rate (maternal mortality per 100,000 births) decreased by 38% from 2000 to 2017. In the United States, however, it has increased steadily from 7.2 deaths per 100,000 live births in 1987 to 17.4 deaths per 100,000 births in 2018. The CDC defines pregnancy-related death as a woman who died during pregnancy or within a year dies after giving birth.
The Policy Statement includes strategies to reduce overall deaths and tackle racial differences in maternal health through a three-pronged approach that focuses on patients, health care providers and care systems. This approach includes:
• Addressing inequalities and inequalities by educating care providers, improving reporting on maternal outcomes, expanding Medicaid funding to states where it does not exist, and raising public awareness of heart disease reduction activities (e.g., smoking cessation) .
• Modernize maternal health care by making women aware of pre-conception counseling, expanding postpartum care for Medicaid participants to the first year after childbirth, and shifting pay by service providers so that high quality and lower costs are paramount unnecessary services are eliminated.
• Updating technology and systems by upgrading public health infrastructure in underserved communities and closing the health care gaps between urban and rural areas.
The policy statement was endorsed by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. It will be presented at the annual AHA national conference in November.
Mehta, LS, et al. (2021) Call to Action: Maternal Health and Maternal Rescue: A Policy Statement from the American Heart Association. traffic. doi.org/10.1161/CIR.0000000000001000.