Alison Cowan, MD, MSCR

It is shocking that more than four in five pregnancy-related deaths are preventable, and the immediate question that arises is, of course, ‘why are women dying?’ and also, ‘what can we do about it?’ We have already taken on some key quality initiatives within the obstetrical community, and this report can help to show us where to redouble our efforts. This report is one that every professional who cares for expecting parents should read.

When we look at the breakdown of the report, what jumps out quickly are a few key points. First, the most significant contributor to maternal deaths is issues related to the heart, high blood pressure and cardiovascular disease, together accounting for 29% of all maternal deaths. This tells us that we need to have cardiovascular health be top of mind in our efforts to improve maternal mortality.

The CDC separates these into three categories, but they’re actually interconnected. For example, cardiomyopathy, a disease severely weakening the heart muscle, is significantly more common in women who have experienced preeclampsia, a high blood pressure complication in pregnancy. We also know that certain cardiac and coronary conditions are much more common in pregnant people with high blood pressure. So, although the CDC separates the three categories, they’re interrelated and interdependent. Furthermore, we must focus on improving them because they drive our worst outcomes. Just one of these categories, cardiac and coronary conditions, was the leading cause of death among non-Hispanic Black people, who have a maternal mortality rate that is 2.9 times that of non-Hispanic white people in the U.S.

These are foundational insights because we have also seen that high blood pressure disorders in pregnancy have doubled over the last 15 years, and now we’re seeing this directly translating to the rising maternal mortality in this country. There is an urgent need to identify patients at risk for high blood pressure disorders during pregnancy and to do everything possible to prevent or mitigate these outcomes.

Of course, this report has much more, in addition to high blood pressure issues and cardiovascular disease. We also need to continue focusing on mental health and support for those with substance use disorders, as well as on the other key drivers of maternal mortality identified by the CDC. But taken together, with cardiovascular and related diseases leading all other causes and accounting for 29% of all maternal mortalities, it’s clear this needs to be a top priority for public health improvements.

Over the last several years, the obstetrical community has introduced several national policies and quality-improvement initiatives designed to combat some of these key drivers of maternal mortality. But there remains much room for improvement. Considering the leading cause of maternal mortality, diseases relating to the heart, high blood pressure and cardiovascular disease, we can do much more to reduce the rate of high blood pressure disorders in pregnancy. We know that a simple intervention — one baby aspirin per day — helps to reduce the risk of preterm preeclampsia by up to 75% for patients who take it as prescribed. Yet, the majority of moms who are at high risk for preeclampsia aren’t receiving it today. We also know that we have an educational gap and that less than half of women know the signs and symptoms of preeclampsia.

It is so important to continue to get the word out on high blood pressure disorders in pregnancy, the signs and symptoms to look for, and what can be done to prevent these outcomes. In our work at Mirvie, we aim to help patients and doctors by providing tools to predict preeclampsia and other pregnancy complications months before they arise. We believe that by predicting these complications, we can give patients and their care team the tools to personalize a care plan, preventing preeclampsia for many women before it occurs. The best cure is prevention, and we should all do everything possible to stop these diseases before they take hold.

It is astounding and unacceptable that over 80% of pregnancy-related deaths are preventable, and it should galvanize us all to action. As noted above, there are numerous national and individual initiatives to improve care for women in this country that we can all contribute to in some way. Shifting the focus to the patient, I hope pregnant people reading this will not feel alarmed, but will feel empowered to talk about their risks and any fears they have with their obstetrical care provider. During pregnancy, the patient’s relationship with their care team is of paramount importance.

Women should feel comfortable asking their care provider any questions that arise during pregnancy. A good one to start with, based on the data, would be, ‘how is my heart health, and what is my risk of developing high blood pressure in pregnancy?’ Opening up this conversation can ensure that those at higher risk feel empowered to do everything to prevent a complication before it happens and that you know the signs and symptoms to look for and when to act on them.

References:

Cameron NA, et al. J Am Heart Assoc. 2022;doi:10.1161/JAHA.121.023791.

Hoyert DL. Maternal Mortality Rates in the United States, 2020. https://stacks.cdc.gov/view/cdc/113967. Published Feb. 23, 2022. Accessed Sept. 23, 2022.

Krishnamurti T, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.30804.

The Preeclampsia Foundation. https://www.preeclampsia.org/educating-patients. Accessed Sept 20, 2022.

Wright D, et al. Am J Obstet Gynecol. 2017;doi:10.1016/j.ajog.2017.08.110.