Abstract
Maternal cardiovascular conditions now surpass hemorrhage and infection as the leading cause of pregnancy-related deaths in the United States, accounting for roughly one-third of preventable maternal fatalities. Unfortunately, stark racial and geographic inequities persist, with Black and Indigenous mothers dying at two to four times the rate of their White peers. Additionally, geography affects the risk, with rural residents facing a significantly higher risk than pregnant patients who deliver in urban centers. The physiologic changes of pregnancy function as a vascular stress test; therefore, pregnancy and postpartum offer a critical window of opportunity to identify women with a high lifetime cardiovascular risk and then to implement prevention strategies. Evidence-based interventions need to be coupled with coordinated system-wide changes in primary preventive care in order to mitigate the rising number of preventable cardiovascular deaths among women in pregnancy and beyond.
Despite evidence of the efficacy of validated screening and prevention protocols, systemic gaps in maternal care persist. Maternal care deserts are expanding. In addition, those areas that offer maternal care often lack sufficient programs that incorporate validated cardiovascular risk-screening tools and do not maintain dedicated cardio-obstetric care teams. Postpartum surveillance for blood pressure and cardiac symptoms remains inconsistent, even
though women with hypertensive disorders of pregnancy are nearly four times as likely to develop chronic hypertension within a year of delivery. Together, these systemic barriers, including fragmented insurance coverage and maternal care deserts with limited access even to telehealth, prevent patients from receiving life-saving essential health care, including cardiac screening and prevention programs.
Here, we will highlight the differences in federal, state, and hospital-level policies that contribute to these gaps. Additionally, we will discuss evidence-based protocols, including standardized safety bundles, remote blood pressure monitoring programs, and multidisciplinary Cardio-OB clinics, that have shown promising improvements in maternal cardiovascular outcomes. Finally, we will propose policy solutions to remove barriers that limit pregnant and postpartum individuals from accessing antenatal and postpartum care in hopes of achieving meaningful, lasting reductions in maternal morbidity and mortality.
Key Take Away Points
- Maternal cardiovascular disease (CVD), both congenital and acquired, is now the leading cause of pregnancy-related deaths in the United States with more than 80% of these deaths deemed preventable.
- Evidence-based CVD screening and prevention programs are efficacious in reducing maternal cardiovascular morbidity and mortality but are hampered by systemic gaps
- Evidence-based interventions need to be coupled with the recommended coordinated system-wide policy changes in order to mitigate the rising number of preventable cardiovascular deaths among women in pregnancy and beyond
Author Biography
Dr. Matthew Mitts, a native Texan, earned his Bachelor’s degree from Trinity University, his medical degree from the University of North Texas, and completed his Obstetrics and Gynecology residency at Baylor College of Medicine. He is current a Maternal-Fetal Medicine Fellow at Yale School of Medicine. His research interests include cardio-obstetrics, hypertensive disorders of pregnancy, and maternal substance use disorders. Dr. Latham is originally from South Carolina. She earned her Bachelor’s degree from Yale College, earned her medical degree from Columbia University College of Physicians and Surgeons, and completed her Obstetrics & Gynecology residency at Medical University of South Carolina. She is currently a Maternal-Fetal Medicine Fellow at Baylor College of Medicine. Her research interests include cardiovascular disease, infectious diseases, and barriers to care in high-risk pregnancies. Dr. Ackerman-Banks is an Assistant Professor in Maternal-Fetal Medicine at Baylor College of Medicine in Houston, Texas. Original from New Jersey, she earned her Bachelor’s degree from Dartmouth College in 2010. She graduated from Columbia University College of Physicians and Surgeons in 2015 and subsequently completed both her Obstetrics & Gynecology residency and Maternal-Fetal Medicine fellowship at Yale University School of Medicine. Her research interests include cardiovascular disease, hypertensive disorders of pregnancy, and severe maternal morbidity.
Recommended Citation
M Mitts, AH Latham, C Ackerman-Banks. (2025) "Addressing Maternal Cardiovascular Mortality: The Role of Policy in Reducing Preventable Deaths and Disparities," Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 15: Iss. 1, Article 1.DOI: https://doi.org/10.58464/2155-5834.1568
Available at: https://digitalcommons.library.tmc.edu/childrenatrisk/vol15/iss1/1
