New Postpartum Care Recommendations Target CVD Risk

Pregnancy-related deaths in the U.S. have risen 140% over the past three decades and cardiovascular disease is the leading cause.[1] Despite existing medical guidance on pregnancy and cardiovascular health, current trends in health outcomes suggest a significant opportunity for an improved system of care, particularly in the postpartum period.

The American Heart Association, the world's leading voluntary organization focused on heart and brain health and this year celebrating 100 years of lifesaving service, recently convened a group of champions with experience in maternal health, postpartum health and/or women's health and cardiovascular disease to develop comprehensive recommendations for enhancing postpartum systems of care. The group also examined health professional education on cardiovascular risks related to pregnancy, with the aim of improving maternal health outcomes and reducing disparities.

"Pregnancy is a cardiopulmonary stress test that may unmask underlying cardiovascular disease or reveal a higher propensity to develop future cardiovascular disease as a result of adverse pregnancy events or outcomes," said Rachel Bond, M.D., a volunteer member of the American Heart Association's Postpartum System of Care Writing Group and women's heart health and prevention specialist. "Heart disease during pregnancy leaves birthing people with a higher lifetime risk of cardiovascular disease after delivery and leads to an increased risk for their children."

The new recommendations call for:

• access to comprehensive health coverage through the first 12 months following birth for all postpartum patients;
• standardized education for all health care professionals who may encounter a pregnant or postpartum patient;
• ​patient-centered holistic care, as well as collaboration and respect for all members of the maternity team, including midwives, doulas, mental health practitioners, community health workers and others; and
• risk-factor monitoring during routine pre-conception and interconception care, including screening for cardiovascular risk factors such as blood pressure, fasting lipid panel, weight and glucose intolerance/diabetes and other lesser-known biomarkers. ​

This is the latest development from the American Heart Association's comprehensive Advancing Maternal Health Through Quality Improvement and Professional Education initiative, launched in July 2022 with funding support from Merck for Mothers, Merck's global maternal health effort to help create a world where no one has to die while giving birth.

"We proudly support the American Heart Association in its relentless work to build longer, healthier lives," said Jacquelyn Caglia, director of learning, communications and U.S. programs for Merck for Mothers. "These new recommendations would greatly expand access to high-quality maternal care for all women across the country and are especially critical for underrepresented groups, whom we know are more likely to be impacted by life-threatening risk factors, such as cardiovascular disease."

In an earlier phase of the Advancing Maternal Health initiative, the Association launched a course on its Professional Education Hub™ on the role of cardiovascular health in maternal health. In the course, interdisciplinary experts identify and explain the increased cardiovascular risk and contributing comorbidities that affect pregnant and recently pregnant individuals with cardiovascular conditions.

The next phase of this important work includes convening maternal health leaders and clinicians who can determine ways to integrate the recommendations as appropriate and monitor the process of inclusion as well as outcomes from adoption. ​