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New ACOG guidelines intended to recognize, reduce CVD in pregnancy, antepartum, postpartum periods

Lisa Hollier

NASHVILLE, Tenn. — The American College of Obstetricians and Gynecologists discussed its recently-released guidance on how to recognize CVD in pregnant, antepartum and postpartum women at a press conference during its Annual Clinical and Scientific Meeting.

"We are missing opportunities to identify risk factors prior to pregnancy and there are often delays in recognizing symptoms during pregnancy and postpartum, particularly for black women. As clinicians, we need to be adept at distinguishing between the two if we're going to improve maternal outcomes," Lisa Hollier, MD, MPH, ACOG president said.

Data indicate 26.5% of deaths in women before, during and after pregnancy are attributable to preventable CVD, more than any other cause, and there are higher percentages of CVD death among poor and minority women, according to the guidelines.

The guidelines encourage clinicians to assess all women for CVD in the antepartum and postpartum periods using the California Improving Health Care Response to Cardiovascular Disease in Pregnancy and Postpartum toolkit algorithm. Nearly 90% of maternal deaths might have been avoided if this algorithm had been used, according to the guidelines.

The ACOG guidance, as well as parts of the California algorithm, state that risk factors for CVD for women in the pregnancy, antepartum, postpartum periods include:

• chronic disease (chronic hypertension or pregestational diabetes mellitus);
• exposure to cardiotoxic drugs;
• history of preterm delivery;
• hypertensive disorders of pregnancy (preeclampsia, eclampsia, or hemolysis, elevated liver enzymes, and low platelet count syndrome);
• moderate to severe obstructive sleep apnea;
• non-Hispanic black race;
• obesity;
• older than 40 years; and
• strong family history of CVD.

Specifically regarding the postpartum period, the guidelines state the risk for CVD is elevated in the period starting immediately after pregnancy and lasting for up to 1 year after delivery. The guidelines also call for to all women with hypertensive disorders to see a primary care physician or cardiologist within 7 to 10 days after delivery. All women with CVD or cardiovascular disorders should have a cardiac evaluation within 7 to 14 days after giving birth.

“We also recommend a comprehensive, cardiovascular postpartum visit at the 3-month mark, at which time the clinician and patient can discuss collaborative plans for yearly follow-up and future pregnancy intentions. It is our job to make sure our clinical practices, policies, and systems reflect our commitment to the health and well-being of the moms in this country,” Hollier said. – by Janel Miller

References: “ACOG Practice Bulletin. Presidential Task Force on Pregnancy and Heart Disease.”

Disclosures: Hollier is ACOG president.