A recent study led by researchers from Somerville, Mass.-based Mass General Brigham found that cardiovascular-related health risks — such as obesity, high blood pressure and diabetes — have been increasing among pregnant women between 2001 and 2019.
About 15% of the 56,000 pregnancies included in the study were affected by heart attack, stroke, heart failure, blood clots, hypertensive disorders or maternal death.
Emily Lau, MD, cardiologist and director of the Women’s Heart Health Program at Brigham and Women’s Hospital and the Cardiometabolic Health and Hormones Clinic at Massachusetts General Hospital, both based in Boston, spoke to Becker’s about what the study’s findings mean for hospital and health system leaders.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What do you see as the most urgent gaps in how hospitals and health systems identify and manage cardiovascular risk in women of reproductive age, particularly during pregnancy?
Dr. Emily Lau: I think the biggest gap that I see is that we are not thinking about cardiovascular health in women of reproductive age at all. There is a common misperception that cardiovascular disease is a disease of older men, but cardiovascular disease is increasingly affecting young women and pregnancy is a particularly vulnerable time for women with cardiovascular disease.
The other important observation is that the burden of cardiometabolic disease like hypertension, diabetes, and obesity, the very risk factors that predispose our patients to greater risk of heart disease later in life, is rising in reproductive aged women. For example, in our recent study, we demonstrated that women entering pregnancy are less healthy and as a result, are more susceptible to developing cardiovascular complications during pregnancy.
Other gaps include: fragmentation of care and unclear ownership — there is lack of clarity of who really “owns” the cardiovascular care of these patients and there is no clear handoff — inconsistent screening, cardiovascular disease risk tools not [being] tailored to reproductive aged women, especially during pregnancy, transition failures and equity gaps.
Q: Given the sharp rise in obesity, hypertension and diabetes among pregnant patients, what models of preventive care do you believe are most effective for addressing these risks?
EL: There are many ways to address cardiovascular prevention in this important population but I think one strategy is to really think about integrated cardio-obstetrics pathways. Not just a clinic, but a true standardized care map for all risk tiers that spans preconception counseling, early pregnancy risk stratification, trimester-specific targets and postpartum management. We need to be leveraging innovative tools including artificial intelligence, remote monitoring and group care to promote the cardiometabolic health of our patients.
Q: What role should women’s heart health programs and cardiology clinics play during and after pregnancy? How can health systems better support cardiac care transitions after pregnancy?
EL: The number of women’s heart health programs and clinics are growing across the country and I think they play an important role in optimizing cardiovascular health for reproductive-aged women both before, during and after pregnancy by serving as the longitudinal home for cardiovascular prevention. However, we also need to be thinking about opportunities to deliver truly multidisciplinary care. Right now, cardiology, obstetrics and maternal-fetal medicine, primary care and endocrinology often work in silos. Can we think of a pregnancy cardiovascular home that prioritizes a team-based care model which will enable smooth transitions of care?
Other strategies that we should be thinking about to support cardiac care transitions after pregnancy include automatic referrals and scheduled appointments, at-home remote monitoring — for example, blood pressure cuffs for hypertensive disorders of pregnancy — telehealth [and] leveraging patient care navigators as part of the larger pregnancy cardiac team to address social needs and ensure attendance at visits.
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