Cardiovascular Disease is the Leading Cause of U.S. Maternal Death

Women in the United States (U.S.) have a higher risk of dying during pregnancy and the postpartum period than women in any other industrialized country. Approximately three in five pregnancy-related deaths in the U.S. are preventable.¹

Cardiovascular disease is the leading cause of maternal death and is responsible for >33% of pregnancy-related deaths, including cardiomyopathy (10.8%), other cardiovascular conditions (15.1%), and cerebrovascular accidents (7.6%).¹ The national trend of increasing maternal age means that more women enter pregnancy with chronic medical conditions and cardiometabolic risk factors such as obesity, high blood pressure, and diabetes. Women who develop complications of pregnancy such as preeclampsia, hypertensive disorders of pregnancy, and/or gestational diabetes are at risk of both adverse pregnancy outcomes and increased risk for cardiovascular disease following pregnancy.²

In 2011, the American Heart Association released guidelines for postpartum follow-up after hypertensive disorders of pregnancy, gestational diabetes, and preterm labor, conditions known to increase risk for cardiovascular disease following pregnancy.³ Recently, there has been increasing attention to the growing need for cardio-obstetric teams to care for women with known cardiovascular risk factors both during and after pregnancy.⁴ This team-based approach, in which nurse navigators can play a key role, may help bridge a significant divide in the care of childbearing women with cardiovascular risk factors who are at greater risk of death during and after pregnancy.

Maternal Mortality

To adequately decrease U.S. maternal mortality rates, it is essential to understand that the root causes are complex. Childbearing women of color, particularly Black and American Indian/Alaska Native (AI/AN) women, die at disproportionate rates. From 2007-2016, the pregnancy-related mortality ratio for Black and AI/AN women aged > 30 years was approximately four to five times that of their White counterparts.⁵ Certainly, insufficient access to care, socioeconomic inequalities, and quality of care matter greatly. However, even among groups with higher levels of education and in states with lower maternal mortality rates, significant racial and ethnic disparities persisted, demonstrating that disparity in maternal mortality for women of color is a complex national problem⁵ and that racism, not race, is a likely risk factor. Implicit bias and structural racism impact the care that childbearing women receive in the U.S. healthcare system, and healthcare provider-level training may make a difference in uncovering and addressing biases that result in delayed or inappropriate maternal care.

Coordination and collaboration among childbearing women, families, providers, maternal health advocates, health systems, and communities are needed to identify and implement prevention strategies to improve women’s health and access to quality care in the preconception, pregnancy, postpartum periods and the years beyond.

References

1. Petersen EE, Davis NL, Goodman D, Cox S, Mayes N, Johnston E, Syverson C, Seed K, Shapiro-Mendoza CK, Callaghan WM and Barfield W. Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019;68:423-429.
2. Ferranti EP, Jones EJ and Hernandez TL. Pregnancy Reveals Evolving Risk for Cardiometabolic Disease in Women. J Obstet Gynecol Neonatal Nurs. 2016;45:413-25.
3. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Pina IL, Roger VL, Shaw LJ, Zhao D, Beckie TM, Bushnell C, D’Armiento J, Kris-Etherton PM, Fang J, Ganiats TG, Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E, Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn VW, Sherif K, Smith SC, Jr., Sopko G, Chandra-Strobos N, Urbina EM, Vaccarino V, Wenger NK and American Heart A. Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American Heart Association. J Am Coll Cardiol. 2011;57:1404-23.
4. Davis MB and Walsh MN. Cardio-Obstetrics. Circ Cardiovasc Qual Outcomes. 2019;12:e005417.
5. Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, Shapiro-Mendoza C, Callaghan WM and Barfield W. Racial/Ethnic Disparities in Pregnancy-Related Deaths – United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2019;68:762-765.