New guidelines for improving maternal cardiovascular health before, during and after pregnancy

Reviewed by Emily Henderson, B.Sc.Sep 24 2021

Thanks largely to the efforts of Johns Hopkins Medicine researchers, the American Heart Association (AHA) recently announced 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 industrialized countries with an estimated 700 deaths a year due to pregnancy complications.

Additionally, the AHA reports that heart disease and stroke contribute to one in three of those deaths, primarily from cardiomyopathy (where the heart loses its ability to effectively pump blood), cerebrovascular disease (conditions that affect blood flow to the brain) or other cardiovascular disorders. For non-Hispanic Black and American Indian/Alaska Native women, it's nearly two to three times higher than the rate for white women.

To bring more awareness to the problem and address it medically, an AHA working group, co-led by cardiologist Garima Sharma, M.D., director of the cardio-obstetrics program at the Johns Hopkins University School of Medicine, created the new guidelines and published them in a policy statement, "Call to Action: Maternal Health and Saving Mothers," posted online Sept. 8, 2021, in the AHA journal Circulation.

The guidelines, says Sharma, also address the inequities hindering proper maternal health care for all.

Regardless of a woman's employment, housing, race or social status, she deserves a health system that ensures a healthy pregnancy, delivery and beyond childbirth as a healthy mom. With a concerted effort, the United States can save maternal lives by implementing simple changes in our patient and provider approach, as well as system overhauls to meet the needs of women in their reproductive years."

Garima Sharma, M.D., director of the cardio-obstetrics program, Johns Hopkins University School of Medicine

In their statement, Sharma and her AHA colleagues outline the inequities that influence disparities, and propose approaches to improving maternal outcomes. Sharma says the guidelines act as a roadmap for policy makers and health care leaders to act on the issue.

"The wheels of science are powered by patient advocacy, and it cannot make an impact in the day-to-day lives of women until policy changes," said Sharma. "This statement pulls together science from decades of data and translates that science into actionable items that could make real change that could ultimately save women's lives."

According to the World Health Organization, the global maternal mortality ratio (maternal deaths per 100,000 births) declined by 38% from 2000 to 2017. However, it has been steadily increasing in the United States from 7.2 deaths per 100,000 live births in 1987 to 17.4 deaths per 100,000 births in 2018. The CDC defines a pregnancy-related death as a woman who dies while pregnant or within one year postpartum.

The policy statement provides strategies to reduce overall deaths and address racial disparities in maternal health through a three-pronged approach focused on patients, health care providers and care systems. This approach includes:

.•    Addressing disparities and inequities by educating providers, improving reporting of maternal outcomes, expanding Medicaid funding in states where it doesn't exist and increasing public awareness about activities to reduce heart disease (such as smoking cessation).
•    Modernizing maternal health care delivery by making women more aware of preconception counseling, expanding postpartum care for Medicaid participants to the first year after delivery and transforming provider payment so it prioritizes high quality, lower cost and removes unnecessary services.
•    Updating technology and systems by modernizing the public health care infrastructure in under-resourced communities and closing the health care gaps between urban and rural areas.

The policy statement has received support from the American College of Obstetricians and Gynecologists, as well as the Society for Maternal-Fetal Medicine. It will be presented at the annual AHA national conference in November.