AHA policy statement calls for ‘multipronged approach’ to improve maternal health
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The American Heart Association issued a policy statement to address the rising rates of maternal mortality in the United States.
As Healio previously reported, pregnancy-related mortality has more than doubled in the U.S. since 1987, and the leading causes of mortality up to 1 year after pregnancy are CVD and cardiomyopathy.
Maternal mortality ‘alarmingly high’
“This statement was initiated by the American Heart Association’s Advocacy Coordinating Committee because maternal mortality in the United States is alarmingly high. It’s approximately 700 deaths in the U.S. per year. It’s estimated that two out of three are preventable, and this is unacceptable,” Cardiology Today Editorial Board Member Laxmi S. Mehta, MD, FACC, FAHA, FNLA, a professor of medicine and the Sarah Ross Soter Endowed Chair in Women’s Cardiovascular Health at the Ohio State University Wexner Medical Center, who chaired the writing committee of the statement, said in an interview. “In addition, the maternal mortality ratio in the U.S. is much higher than 10 other developed nations. And so, the committee felt that there needs to be a call to action on maternal health.”
The policy statement, supported by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, outlines drivers of disparities that contribute to elevated maternal mortality rates in certain populations and makes recommendations to improve maternal mortality.
“The most important take-home message is that one thing is not going to fix the whole problem. It’s going to require a multipronged approach,” Garima Sharma, MD, FACC, FACP, assistant professor of medicine at Johns Hopkins University School of Medicine and vice chair of the writing committee, told Healio. “It’s going to require many different things that need to be done together, and simultaneously, to be able to reverse this trend.”
According to the statement, it is crucial to identify factors that place women at high CV risk during pregnancy.
In addition, the authors wrote, racial and socioeconomic determinants of health can impact maternal mortality.
“In fact, there’s even evidence that suggests that structural racism may be a contributor to disparities in maternal outcomes,” Mehta told Healio.
Among the suggestions the statement offers to improving maternal health “is to improve the awareness among women about a need for preconceptual counseling for them to recognize the risk factors during pregnancy,” Mehta said. “Counseling that we provide to our patients preconception is essential. Education is an important step to achieving cultural competency, bias reduction and making sure that all are treated equally.”
Other steps that should be taken, Sharma said, include “providing better reporting, improving quality reporting of maternal outcomes, as well as better surveillance systems to monitor key maternal and infant health indicators; and funding maternal initiatives and research in systemic inequities. Lastly, expanding postpartum care, including expanding Medicaid to cover beyond 60 days postpartum, is critical.”
Improving provider education
A broader understanding of cardio-obstetrics in the general medical community would also help, Sharma told Healio.
“Cardio-obstetrics is an evolving field, and this should be taught very early,” she said. “We’re teaching cardio-obstetrics to advanced fellows, but cardiology and maternal health care should be taught to everyone that sees young women. Having this as a part of the internal medicine curriculum or family medicine curriculum, or having cardiology as a part of the maternal-fetal medicine curriculum, is important.”
Adoption of the proposals and improvements in maternal health are “not going to happen overnight,” Mehta said in an interview. “But it’s certainly something that we need to work on over the next several years to make an impact, not only for our mothers, but for the future health of America and these children.”
For more information:
Laxmi S. Mehta, MD, FACC, FAHA, FNLA, can be reached at laxmi.mehta@osumc.edu.
Garima Sharma, MD, can be reached at gsharma8@jhmi.edu.
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