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Mehta A, Spitz J, Sharma S, Bonomo J, Brewer LC, Mehta LS, Sharma G. Addressing Social Determinants of Health in Maternal Cardiovascular Health. Can J Cardiol 2024; 40:1031-1042. [PMID: 38387722 DOI: 10.1016/j.cjca.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain the number-one cause of maternal mortality, with over two-thirds of cases being preventable. Social determinants of health (SDoH) encompass the nonmedical social and environmental factors that an individual experiences that have a significant impact on their health. These stressors disproportionately affect socially disadvantaged and minority populations. Pregnancy is a physiologically stressful state that can unmask underlying CVD risk factors and lead to adverse pregnancy outcomes (APOs). Disparities in APOs are particularly pronounced among individuals of color and those from economically disadvantaged backgrounds. This variation underscores healthcare inequity and access, a failure of the healthcare system. Besides short-term negative effects, APOs also are associated strongly with long-term CVDs. APOs therefore must be identified as a cue for early intervention, for the prevention and management of CVD risk factors. This review explores the intricate relationship among maternal morbidity and mortality, SDoH, and cardiovascular health, and the implementation of health policy efforts to reduce the negative impact of SDoH in this patient population. The review emphasizes the importance of comprehensive strategies to improve maternal health outcomes.
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Affiliation(s)
- Adhya Mehta
- Department of Internal Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA
| | - Jared Spitz
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - Sneha Sharma
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jason Bonomo
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Laxmi S Mehta
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Garima Sharma
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA.
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Lewey J, Beckie TM, Brown HL, Brown SD, Garovic VD, Khan SS, Miller EC, Sharma G, Mehta LS. Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e330-e346. [PMID: 38346104 PMCID: PMC11185178 DOI: 10.1161/cir.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.
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Labgold K, Howards PP, Drews-Botsch C, Dunlop AL, Bryan JM, Ruddock T, Johnston S, Kramer MR. Decomposing the Black-White Racial Disparity in Severe Maternal Morbidity Risk: The Role of Hypertensive Disorders of Pregnancy. Epidemiology 2024; 35:94-102. [PMID: 37793115 DOI: 10.1097/ede.0000000000001683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND To our knowledge, no studies have explicitly studied the role of hypertensive disorders of pregnancy (HDP) in racial disparities in severe maternal morbidity (SMM). METHODS Using causal mediation models, we estimated the proportion of the non-Hispanic (NH) Black-White racial disparity in risk of SMM that is explained through the pathway of HDP. We linked 2006-2019 Georgia hospital discharge records with vital statistics birth and fetal death records for NH Black and NH White birthing persons. We used G-estimation of a structural nested mean model to decompose the absolute racial disparity in the incidence of SMM into pathways operating through HDP. RESULTS NH Black birthing people experienced an excess 56 SMM events (95% confidence interval [CI] = 52, 59) per 10,000 delivery hospitalizations compared with NH White birthing people. If counterfactual disparity measure estimation assumptions hold, the estimated absolute disparity remaining after blocking the causal pathways through HDP was 41 SMM events per 10,000 deliveries (95% CI = 38, 44), suggesting that 26% (95% CI = 12, 40) of the absolute racial disparity would be eliminated if there was no contribution of HDP to SMM risk. CONCLUSION Our results are consistent with the hypothesis that intervening to prevent HDP is an important (yet incomplete) pathway for reducing the excess risk among NH Black pregnancies compared with NH White pregnancies.
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Affiliation(s)
- Katie Labgold
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Penelope P Howards
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Carolyn Drews-Botsch
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Global and Community Health, School of Health and Human Services, George Mason University, Fairfax, VA
| | - Anne L Dunlop
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA
| | | | | | | | - Michael R Kramer
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Obeng CS, Jackson F, Brandenburg D, Byrd KA. Black/African American Women's Woes: Women's Perspectives of Black/African American Maternal Mortality in the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01883-0. [PMID: 38051429 DOI: 10.1007/s40615-023-01883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Despite advances in perinatal care in the USA, maternal mortality is on the rise, and maternal death is higher than in any other high-income country. Maternal mortality in the USA is a persistent public health concern. This issue disproportionately affects Black/African American women, with their likelihood of pregnancy-related death being three times more likely compared to White women. This study aimed to explore the resources needed for Black/African American women to address the relatively higher maternal mortality rates recorded for them. METHODS An anonymous link with demographic and open-ended questions was sent to US women 18 years and older to participate in the study. A total of 140 participants responded to the survey. We retained a final sample of 118 responses after eliminating responses with missing data. Descriptive statistics are reported for closed-ended items. Open-ended responses were analyzed using content analysis procedures, where we coded and categorized the data into themes. RESULTS Six themes were identified from the study data: (1) Diversity, Equity, and Inclusion (DEI) training for health providers focused on racial bias and discrimination, (2) Advocacy, (3) Provider selection, (4) Researching doctors and delivery hospitals to inform women's birthing decision-making, (5) Women's care-seeking behaviors, and (6) Addressing the Social Determinants of Health. CONCLUSION Based on the study's findings, we recommend DEI training for healthcare professionals providing direct care to pregnant and postpartum women, advocacy and resource-awareness training for pregnant Black/African American women and their spouses/partners, or a family member, to assist them in their pregnancy and birthing journeys.
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Affiliation(s)
- Cecilia S Obeng
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA.
| | - Frederica Jackson
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Dakota Brandenburg
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Kourtney A Byrd
- College of Pharmacy, Center for Health Equity and Innovation (CHEqI), Purdue University, Indianapolis, IN, USA
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Bolakale-Rufai IK, Knapp SM, Johnson AE, Brewer L, Mohammed S, Addison D, Mazimba S, Tucker-Edmonds B, Breathett K. Association Between Race, Cardiology Care, and the Receipt of Guideline-Directed Medical Therapy in Peripartum Cardiomyopathy. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01838-5. [PMID: 37870730 PMCID: PMC11035491 DOI: 10.1007/s40615-023-01838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Black patients with peripartum cardiomyopathy (PPCM) have disproportionately worse outcomes than White patients, possibly related to variable involvement of cardiovascular specialists in their clinical care. We sought to determine whether race was associated with cardiology involvement in clinical care during inpatient admission and whether cardiology involvement in care was associated with higher claims of guideline-directed medical therapy (GDMT) a week after hospital discharge. METHODS Using Optum's de-identified Clinformatics® Data Mart (CDM), we included Black and White patients' first hospital admission for PPCM from 2008 to 2021. Cardiology involvement in clinical care was defined as the receipt of attending care from a cardiovascular specialist during admission. GDMT included beta-blockers (BB) for all patients and triple therapy (BB, angiotensin-responsive medications, and mineralocorticoid receptor antagonists) for non-pregnant patients. Logistic regression was used to determine the associations between cardiology involvement in clinical care during admission and (1) patient race and (2) GDMT prescription, adjusting for age and comorbidities. RESULTS Among 668 patients (32.6% Black, 67.4% White, 93.3% commercially insured), there was no significant difference in the odds of cardiology involvement in clinical care by race (aOR: 1.41; 95%CI: 0.87-2.33, P=0.17). Inpatient cardiology care was associated with 2.75 times increased odds of having a prescription claim for GDMT (BB) for White patients (aOR: 2.75; 95%CI 1.50-5.06, P=0.001), and the estimated effect size was similar but not statistically significant for Black patients (aOR: 2.20, 95% CI, 0.84-5.71, P=0.11). The interaction between race and cardiology involvement in clinical care was not statistically significant for the receipt of BB prescription. Among 274 non-pregnant patients with PPCM (37.2% Black, 62.8% White), 5.8% received triple GDMT. Of these, none of the Black patients lacking cardiology care had triple GDMT. However, cardiology involvement in care was not significantly associated with triple GDMT for either race. CONCLUSIONS Among a commercially insured population within PPCM, race was not associated with cardiology involvement in clinical care during hospitalization. However, cardiology involvement in care was associated with significantly higher odds of prescription claims for BB for only White patients. Additional strategies are needed to support equitable GDMT prescription.
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Affiliation(s)
- Ikeoluwapo Kendra Bolakale-Rufai
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN, 46202, USA
| | - Shannon M Knapp
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN, 46202, USA
| | - Amber E Johnson
- Division of Cardiology, University of Chicago, Chicago, IL, USA
| | | | - Selma Mohammed
- Division of Cardiology, Creighton University, Omaha, USA
| | - Daniel Addison
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, USA
| | | | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN, 46202, USA.
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Eapen D, Mbango C, Daniels G, Mathew Joseph N, Mary A, Mathews N, Carr KK, Wells C, Suriaga A, Saint Fleur A. Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group. Res Nurs Health 2023; 46:457-461. [PMID: 37525299 DOI: 10.1002/nur.22332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy-related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed.
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Affiliation(s)
- Doncy Eapen
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Catherine Mbango
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Glenda Daniels
- Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, Texas, USA
| | - Nitha Mathew Joseph
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Annapoorna Mary
- Loewenberg College of Nursing, The University of Memphis, Memphis, Tennessee, USA
| | - Nisha Mathews
- College of Human Sciences and Humanities, University of Houston-Clear Lake (Pearland), Pearland, Texas, USA
| | - Kathryn Kravetz Carr
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Cheryl Wells
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Armiel Suriaga
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Mehta LS, Velarde GP, Lewey J, Sharma G, Bond RM, Navas-Acien A, Fretts AM, Magwood GS, Yang E, Blumenthal RS, Brown RM, Mieres JH. Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity: A Scientific Statement From the American Heart Association. Circulation 2023; 147:1471-1487. [PMID: 37035919 PMCID: PMC11196122 DOI: 10.1161/cir.0000000000001139] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Cardiovascular disease is the leading cause of death in women, yet differences exist among certain racial and ethnic groups. Aside from traditional risk factors, behavioral and environmental factors and social determinants of health affect cardiovascular health and risk in women. Language barriers, discrimination, acculturation, and health care access disproportionately affect women of underrepresented races and ethnicities. These factors result in a higher prevalence of cardiovascular disease and significant challenges in the diagnosis and treatment of cardiovascular conditions. Culturally sensitive, peer-led community and health care professional education is a necessary step in the prevention of cardiovascular disease. Equitable access to evidence-based cardiovascular preventive health care should be available for all women regardless of race and ethnicity; however, these guidelines are not equally incorporated into clinical practice. This scientific statement reviews the current evidence on racial and ethnic differences in cardiovascular risk factors and current cardiovascular preventive therapies for women in the United States.
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Meyerovitz CV, Juraschek SP, Ayturk D, Moore Simas TA, Person SD, Lemon SC, McManus DD, Kovell LC. Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018. J Am Heart Assoc 2023; 12:e027169. [PMID: 36847043 PMCID: PMC10111464 DOI: 10.1161/jaha.122.027169] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/30/2022] [Indexed: 03/01/2023]
Abstract
Background Hypertension is an important modifiable risk factor of serious maternal morbidity and mortality. Social determinants of health (SDoH) influence hypertension outcomes and may contribute to racial and ethnic differences in hypertension control. Our objective was to assess SDoH and blood pressure (BP) control by race and ethnicity in US women of childbearing age with hypertension. Methods and Results We studied women (aged 20-50 years) with hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or use of antihypertensive medication) in the National Health and Nutrition Examination Surveys 2001 to 2018. SDoH and BP control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) were examined by race and ethnicity (White race, Black race, Hispanic ethnicity, and Asian race). Using multivariable logistic regression, odds of uncontrolled BP by race and ethnicity were modeled, adjusting for SDoH, health factors, and modifiable health behaviors. Responses on hunger and affording food determined food insecurity status. Across women of childbearing age with hypertension (N=1293), 59.2% were White race, 23.4% were Black race, 15.8% were Hispanic ethnicity, and 1.7% were Asian race. More Hispanic and Black women experienced food insecurity than White women (32% and 25% versus 13%; both P<0.001). After SDoH, health factor, and modifiable health behavior adjustment, Black women maintained higher odds of uncontrolled BP than White women (odds ratio, 2.31 [95% CI, 1.08-4.92]), whereas Asian and Hispanic women showed no difference. Conclusions We identified racial inequities in uncontrolled BP and food insecurity among women of childbearing age with hypertension. Further exploration beyond the SDoH measured is needed to understand the inequity in hypertension control in Black women.
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Affiliation(s)
| | - Stephen P. Juraschek
- Division of General MedicineBeth Israel Deaconess Medical Center/Harvard Medical SchoolBostonMA
| | - Didem Ayturk
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMA
| | - Tiffany A. Moore Simas
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMA
- Departments of Obstetrics and Gynecology, Pediatrics and PsychiatryUMass Chan Medical SchoolWorcesterMA
| | - Sharina D. Person
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMA
| | - Stephenie C. Lemon
- Department of Population and Quantitative Health SciencesUMass Chan Medical SchoolWorcesterMA
| | - David D. McManus
- Division of Cardiovascular Medicine, Department of MedicineUMass Chan Medical SchoolWorcesterMA
| | - Lara C. Kovell
- Division of Cardiovascular Medicine, Department of MedicineUMass Chan Medical SchoolWorcesterMA
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Bryant AS, Coleman J, Shi X, Rodriguez M, Papadopoulos AS, Merz K, Leonard J, Samia N, Marceau L. The Power and Promise of Postpartum Self Care: Evaluation of a Web-Based Tool for Underserved Women. Matern Child Health J 2023; 27:548-555. [PMID: 36732464 PMCID: PMC9894665 DOI: 10.1007/s10995-023-03605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Joyuus is a culturally diverse, comprehensive online tool designed to address the self-care needs of underserved postpartum women. The tool provides actionable self-care information, knowledge, and skills to improve postpartum health and identifies red flags for when self-care shifts to seeking care. METHODS We employed a mixed-methods multiphase design to evaluate the Joyuus prototype, including a pre-post evaluation (N = 87) to assess behavioral health outcomes before and after using the tool for a one-month period. 91% completed the post-test (N = 79). The analysis focused on estimation of treatment effect (via 95% confidence intervals) and fitness of instruments in this population. RESULTS Participants were between 6 months pregnant and one year postpartum, a mean age of 30 years, 100% female, 99% Black, with nearly equal distribution of married (55%) and not married (44%), and above (47%) and below (46%) annual income of $60 K. Key measures saw significant improvement from pre- (mean = 26.44, SD = 5.39) to post (mean = 28.29, SD = 5.26) on the Connor-Davidson Resilience Scale (p < 0.001) Trends toward improvement (not statistically significant) were noted for Depression (EPDS) (p = 0.624) and Anxiety (STAI) (p = 0.286), and no meaningful change on MOS Social Support or COVID-19 Mental Health Impacts Measures. CONCLUSIONS FOR PRACTICE This pilot study demonstrates that a self-care mobile tool has the potential to address significant health outcomes related to maternal morbidity and mortality. By providing a continuously available companion addressing physical, mental, and real-life questions, it creates value during postpartum for mothers who can often feel overwhelmed or isolated.
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Affiliation(s)
- Allison S Bryant
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Julia Coleman
- HealthCore, Inc., 55 Chapel Street, Newton, MA, 02458, USA
| | - Xiaomei Shi
- Collective Insight, 4 Pickard Ln, North Reading, MA, 01864-2451, USA
- LeadingAge LTSS Center at the University of Massachusetts, 100 Morrissey Blvd., Boston, MA, 02125, USA
| | | | | | - Kristine Merz
- Joyuus, LLC, 15 Victory Highway, West Greenwich, RI, 02817, USA
- Orange Square, 15 Victory Highway, West Greenwich, RI, 02817, USA
| | - Juli Leonard
- Orange Square, 15 Victory Highway, West Greenwich, RI, 02817, USA
| | - Neela Samia
- Orange Square, 15 Victory Highway, West Greenwich, RI, 02817, USA
| | - Lisa Marceau
- Joyuus, LLC, 15 Victory Highway, West Greenwich, RI, 02817, USA.
- Alpha Millennial Health, Cumberland, RI, USA.
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Khan SS, Brewer LC, Canobbio MM, Cipolla MJ, Grobman WA, Lewey J, Michos ED, Miller EC, Perak AM, Wei GS, Gooding H. Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e76-e91. [PMID: 36780391 PMCID: PMC10080475 DOI: 10.1161/cir.0000000000001124] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.
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Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States. Healthcare (Basel) 2023; 11:healthcare11030438. [PMID: 36767014 PMCID: PMC9914526 DOI: 10.3390/healthcare11030438] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality.
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12
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Somerville K, Rowell T, Stadulis R, Bell D, Neal-Barnett A. An evaluation of the feasibility and acceptability of sister circles as an anxiety intervention for pregnant Black women. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231185405. [PMID: 37480300 PMCID: PMC10363880 DOI: 10.1177/17455057231185405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Black women and their infants face heightened health risks during pregnancy, labor, and delivery that, for many, cost them their lives. Such health risks during this critical period are linked to increased rates of anxiety among Black pregnant and postpartum women. Black women also endure racism when seeking support from mental health and healthcare providers, which further contributes to pregnancy and postpartum-related anxiety. Evidence on sister circles has demonstrated that this indigenous form of healing may provide Black pregnant and postpartum women with the support and skills needed to cope with stressors associated with mental and physical health concerns and racism. OBJECTIVE Our study aimed to evaluate the feasibility and acceptability of the Birthing Beautiful Babies Sisters Offering Support, a sister circle cognitive behavioral therapy-based stress and anxiety intervention for Black pregnant and postpartum women. DESIGN Our study employed a mixed-methods framework. METHODS Descriptive analyses, paired samples t-test, and open and selective coding were conducted. We utilized the following measures: Penn State Worry Questionnaire-Abbreviated, Kessler Psychological Distress Scale, Pregnancy-Related Anxiety Scale, focus booklet, and focus group discussion. RESULTS Participants reported experiencing moderate levels of worry and distress and low levels of pregnancy-related anxiety prior to the start of the Birthing Beautiful Babies Sisters Offering Support intervention. Eighty women participated in Birthing Beautiful Babies Sisters Offering Support. Eleven focus groups were conducted to assess their experience. Participants reported a perceived increase in their knowledge about panic attacks and stress and ability to manage stressors effectively. They found that all completed activities contributed to their development and application of skills. They reported they enjoyed Birthing Beautiful Babies Sisters Offering Support because of the supportive environment, openness, and emphasis on sisterhood. Participants provided helpful feedback about the structure and flow of the intervention. CONCLUSION Limitations of the present study and future directions are discussed.
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Affiliation(s)
| | | | | | - Debra Bell
- Birthing Beautiful Communities, Cleveland, OH, USA
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Social Media and Cardiovascular Health: Implications for Women. Curr Atheroscler Rep 2022; 24:901-913. [PMID: 36441421 PMCID: PMC10017051 DOI: 10.1007/s11883-022-01069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of mortality in adult women in the USA, yet CVD is underrecognized in women. Disparities in care are further pronounced in women of racial/ethnic minority backgrounds. In this review, we discuss the role of social media (SoMe) as a tool to (i) promote women's cardiovascular (CV) health and (ii) address and potentially reduce gaps in care, particularly in general cardiology (targeting atherosclerotic cardiovascular disease), cardio-oncology, and cardio-obstetrics. We also briefly discuss women's CV health as a common, although not unique, focus of women in cardiology on SoMe. RECENT FINDINGS Studies have suggested the utility of social media to help advance subspecialties of cardiology. Leaders within general cardiology, cardio-oncology, and cardio-obstetrics have curated social media strategies to advance their respective fields and call attention to cardiovascular health disparities in female populations and racial/ethnic minorities. In addition to these types of uses, women in cardiology also frequently use SoMe to encourage a career in cardiology and to share experiences, challenges, and resources for support and career advancement as healthcare professionals; men in cardiology and especially those who are allies for sex and racial/ethnic minorities also use SoMe for these means. Herein, we highlight the role and myriad applications of social media in the promotion of women's cardiovascular health. We discuss five primary roles of social media: increasing public awareness, disseminating medical literature in a rapid and accessible fashion, facilitating professional networking, serving as a platform for medical conferences, and empowering patients. These core strategies are discussed through the lens of general cardiology, cardio-oncology, and cardio-obstetrics. We also demonstrate how these applications can be leveraged to increase representation of women in cardiology, also supporting an increased focus on women's cardiovascular health.
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Grayson N, Quinones N, Oseguera T. A Model of True CHOICES: Learnings from a Comprehensive Sexual and Reproductive Health Clinic in Tennessee that Provides Abortions and Opened the City's First Birth Center. J Midwifery Womens Health 2022; 67:689-695. [PMID: 36471539 DOI: 10.1111/jmwh.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/16/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
CHOICES Memphis Center for Reproductive Health staff is passionate about ensuring that everyone has access to the full continuum of comprehensive reproductive health care (including abortion, gender-affirming care, miscarriage management, and community birth) regardless of race, gender identity, sexual orientation, HIV status, economic status, or religious beliefs. Memphis, Tennessee, has a history of limited community birth options (birthing outside of hospital walls). In 2017, when home birth services were added to CHOICES and plans for opening Memphis' first freestanding birth center were being imagined, it was intentional to create a model in which midwifery care could be accessible for patients who may be eligible for state-funded health care services, those considered at higher health risk than traditional low-risk midwifery patients, or both. In fact, individuals and their families with limited out-of-pocket funds and those historically marginalized would purposely receive holistic, individualized care based on their unique health care needs and personal desires, driven by a reproductive justice framework. In this article, we outline the success and challenges of addressing the reproductive health needs of marginalized communities, including the benefits of a nonprofit business model, operationalizing reproductive justice concepts, and the reclamation of Black midwifery. We also discuss the challenges of caring for Black birthing people and providing abortion and gender-affirming care in a politically hostile environment. Although individuals have complex needs, at its core, CHOICES believes that every person must be seen as whole human beings and that each can be cared for by a midwife. The CHOICES approach is informed by evidence-based information, clinical judgment, and an intentional partnership with and investment in a people who have historically been and are presently pushed to the margins, neglected, and blamed for poor health outcomes and demise. Striving to adapt the CHOICES model of care in other parts of the country is important now more than ever following the Supreme Court decision to overturn Roe v. Wade.
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Affiliation(s)
- Nikia Grayson
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
| | - Nicole Quinones
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
| | - Talita Oseguera
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
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Wolfe DS, Liu C, Alboucai J, Karten A, Mushi J, Yellin S, Berkowitz JL, Vega S, Felix N, Liaqat W, Kankaria R, Vorawandthanachai T, Bortnick AE. Maternal Outcomes in Women with Peripartum Cardiomyopathy versus Age and Race-Matched Peers in an Urban US Community. J Cardiovasc Dev Dis 2022; 9:jcdd9080250. [PMID: 36005414 PMCID: PMC9410188 DOI: 10.3390/jcdd9080250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is idiopathic systolic congestive heart failure around pregnancy. Comparisons with matched controls are lacking. We investigated maternal characteristics and outcomes up to 12 months in a cohort admitted to Montefiore Health System in Bronx, New York 1999−2015 (n = 53 cases and n = 92 age and race-matched controls, >80% Black or Hispanic/Latina). Compared to peers, women with PPCM had more chronic hypertension (24.5% vs. 8.8%, p = 0.001), prior gestational hypertension (20.8% vs. 5.4%, p = 0.001), prior preeclampsia (17.0% vs. 3.3%, p = 0.001), familial dilated cardiomyopathy (5.7% vs. 0.0%, p = 0.04), smoking (15.1% vs. 2.2%, p = 0.001), lower summary socioeconomic scores (−4.12 (IQR −6.81, −2.13) vs. −1.62 (IQR −4.20, −0.74), p < 0.001), public insurance (67.9% vs. 29.3% p = 0.001), and frequent depressive symptoms. Women with PPCM were often admitted antepartum (34.0% vs. 18.5%, p = 0.001) and underwent Cesarean section (65.4% vs. 30.4%, p = 0.001), but had less preterm labor (27.3% vs. 51.1%, p = 0.001). Women were rarely treated with bromocriptine (3.8%), frequently underwent left ventricular assist device placement (9.4% and n = 2 with menorrhagia requiring transfusion and progesterone) or heart transplantation (3.8%), but there were no in-hospital deaths. In sum, women with PPCM had worse socioeconomic disadvantage and baseline health than matched peers. Programs addressing social determinants of health may be important for women at high risk of PPCM.
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Affiliation(s)
- Diana S. Wolfe
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence:
| | - Christina Liu
- Department of Emergency Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY 11206, USA
| | - Jack Alboucai
- Department of Medicine, North Shore University Hospital, Manhasset, NY 11030, USA
| | - Ariel Karten
- Department of Medicine, Division of Cardiology, New York University Long Island School of Medicine, Mineola, NY 11501, USA
| | - Juliet Mushi
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University Maternal Fetal Medicine, Greenwich Hospital, Greenwich, CT 06830, USA
| | - Shira Yellin
- Department of Medicine, Mount Sinai Health System, New York, NY 10029, USA
| | - Julia L. Berkowitz
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Shayna Vega
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Center, Oakland, CA 94611, USA
| | - Nicole Felix
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Wasla Liaqat
- Department of Medicine, New York Health and Hospitals Jacobi Medical Center, Bronx, NY 10461, USA
| | - Rohan Kankaria
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Anna E. Bortnick
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Division of Geriatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Rollins L, Giddings T, Henes S, Culbreth W, Coleman AS, Smith S, White C, Nelson T. Design and Implementation of a Nutrition and Breastfeeding Education Program for Black Expecting Mothers and Fathers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:794-803. [PMID: 35610157 DOI: 10.1016/j.jneb.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the intervention and research methods of Project Dads in Nutrition Education, an intervention that adds nutrition and breastfeeding education to the existing Healthy Start program in Georgia for Black expecting mothers and fathers to improve nutrition literacy, health outcomes, and breastfeeding rates. DESIGN This 2-year community-based participatory research study employs a cluster randomization factorial design. SETTING Six Healthy Start program sites (3 intervention and 3 control sites) in Georgia counties with high infant and maternal mortality rates. PARTICIPANTS Approximately 480 Black, expecting, Healthy Start program participants (20 couples [mother and father] and 40 single mothers from each site) will be enrolled over the study period. INTERVENTION(S) Project Dads in Nutrition Education will strengthen the capacity of the Georgia Healthy Start program to integrate an evidence-based nutrition education program, breastfeeding education, and father engagement into its routine services. MAIN OUTCOME MEASURE(S) Changes in prepost survey assessment of participants' nutrition literacy and eating behaviors; changes in prepost survey assessment of participants' breastfeeding knowledge, attitudes, intent, initiation, and duration; and health and food diary collected 3 times (ie, at baseline, 3 months, and 6 months after enrollment). ANALYSIS Process evaluation throughout the study to document implementation. Generalized linear mixed modeling will be used to determine the impact of the intervention.
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Affiliation(s)
- Latrice Rollins
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA.
| | - Tiara Giddings
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Sarah Henes
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA
| | - Wykinia Culbreth
- Maternal and Child Health Division, Georgia Department of Public Health, Atlanta, GA
| | | | - Shlonda Smith
- Special Supplementation Nutrition Program for Women, Infants, and Children, Georgia Department of Public Health, Atlanta, GA
| | | | - Twanna Nelson
- Maternal and Child Health Division, Georgia Department of Public Health, Atlanta, GA
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17
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Bond RM, Phillips K, Ivy KN, Ogueri V, Parapid B, Miller SC, Ansong A. Cardiovascular Health of Black Women Before, During, and After Pregnancy: A Call to Action and Implications for Prevention. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Kyalwazi AN, Loccoh EC, Brewer LC, Ofili EO, Xu J, Song Y, Joynt Maddox KE, Yeh RW, Wadhera RK. Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019. Circulation 2022; 146:211-228. [PMID: 35861764 DOI: 10.1161/circulationaha.122.060199] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation. METHODS We used CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation. RESULTS From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9-160.3]; 2019: ARD, 84.3 [95% CI, 81.2-87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6-194.6]; 2019: ARD, 130.3 [95% CI, 125.6-135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30-1.33])- especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23-2.32])-as well as for Black men (rate ratio, 1.33 [95% CI, 1.32-1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels. CONCLUSIONS During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.
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Affiliation(s)
- Ashley N Kyalwazi
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.).,Harvard Medical School, Boston, MA (A.N.K.)
| | - Eméfah C Loccoh
- Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.C.L.)
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN (L.C.B.)
| | - Elizabeth O Ofili
- Division of Cardiology and the Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (E.O.O.)
| | - Jiaman Xu
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Yang Song
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Karen E Joynt Maddox
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (K.E.J.M.)
| | - Robert W Yeh
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Rishi K Wadhera
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
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Arrhythmias and Heart Failure in Pregnancy: A Dialogue on Multidisciplinary Collaboration. J Cardiovasc Dev Dis 2022; 9:jcdd9070199. [PMID: 35877562 PMCID: PMC9320047 DOI: 10.3390/jcdd9070199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/04/2023] Open
Abstract
The prevalence of CVD in pregnant people is estimated to be around 1 to 4%, and it is imperative that clinicians that care for obstetric patients can promptly and accurately diagnose and manage common cardiovascular conditions as well as understand when to promptly refer to a high-risk obstetrics team for a multidisciplinary approach for managing more complex patients. In pregnant patients with CVD, arrhythmias and heart failure (HF) are the most common complications that arise. The difficulty in the management of these patients arises from variable degrees of severity of both arrhythmia and heart failure presentation. For example, arrhythmia-based complications in pregnancy can range from isolated premature ventricular contractions to life-threatening arrhythmias such as sustained ventricular tachycardia. HF also has variable manifestations in pregnant patients ranging from mild left ventricular impairment to patients with advanced heart failure with acute decompensated HF. In high-risk patients, a collaboration between the general obstetrics, maternal-fetal medicine, and cardiovascular teams (which may include cardio-obstetrics, electrophysiology, adult congenital, or advanced HF)—physicians, nurses and allied professionals—can provide the multidisciplinary approach necessary to properly risk-stratify these women and provide appropriate management to improve outcomes.
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20
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Parapid B, Rakić S. Oral Contraception: Beyond What Meets the Eye. Sorry, the Ovaries! INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20220085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Baiden D, Parry M, Nerenberg K, Hillan EM, Dogba MJ. Connecting the Dots: Structural Racism, Intersectionality, and Cardiovascular Health Outcomes for African, Caribbean, and Black Mothers. Health Equity 2022; 6:402-405. [PMID: 35801154 PMCID: PMC9257546 DOI: 10.1089/heq.2021.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
African, Caribbean, and Black (ACB) women globally experience health inequities that impact on their cardiovascular health outcomes during the perinatal period, and for years after. Aside from being at a high risk of having and dying from hypertensive disorders of pregnancy, ACB women who survive face a lifelong risk of cardiovascular disease years after the diagnosis. Racism as a determinant of health intersects with gender, societal structures, and immigration status to contribute to cardiovascular health and access to quality health care services for ACB women. Equitable policies and culturally appropriate programs are needed to improve the cardiovascular health of ACB women.
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Affiliation(s)
- Deborah Baiden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kara Nerenberg
- Department of Medicine, Obstetrics & Gynecology, Community Health Sciences, University of Calgary, Calgary, Canada
| | - Edith M. Hillan
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Quebec, Canada
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22
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Kwapong YA, Boakye E, Obisesan OH, Shah LM, Ogunwole SM, Hays AG, Blumenthal RS, Creanga AA, Blaha MJ, Cainzos-Achirica M, Nasir K, Douglas PS, Wang X, Sharma G. Nativity-Related Disparities in Preterm Birth and Cardiovascular Risk in a Multiracial U.S. Cohort. Am J Prev Med 2022; 62:885-894. [PMID: 35597568 DOI: 10.1016/j.amepre.2021.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Having a preterm birth is associated with future cardiovascular risk. Non-Hispanic Black women have higher rates of preterm birth than non-Hispanic White and Hispanic women, but nativity-related disparities in preterm birth are not well understood. METHODS Data from 6,096 women in the Boston Birth Cohort: non-Hispanic Black (2,699), non-Hispanic White (997), or Hispanic (2,400), were analyzed in June 2021. Differences in cardiovascular risk factors were assessed. The association of preterm birth with nativity and duration of U.S. residence were investigated using multivariable logistic regression. RESULTS U.S.-born women in all 3 racial-ethnic groups had a higher prevalence of obesity, smoking, and severe stress than foreign-born women. Foreign-born non-Hispanic Black and Hispanic women had lower odds of preterm birth than U.S.-born counterparts (non-Hispanic Black: AOR=0.79, 95% CI=0.65, 0.97; Hispanic: AOR=0.72, 95% CI=0.56, 0.93). In all the 3 groups, foreign-born women with shorter (<10 years) duration of U.S. residence had lower odds of preterm birth than the U.S.-born women (non-Hispanic Black: AOR=0.57, 95% CI=0.43, 0.75; Hispanic: AOR=0.72, 95% CI=0.55, 0.94; non-Hispanic White: AOR=0.46, 95% CI=0.25, 0.85), whereas the odds of preterm birth in foreign-born women with ≥10 years of residence were not significantly different. CONCLUSIONS Foreign-born women had better cardiovascular risk profiles in all groups and lower odds of preterm birth in non-Hispanic Black and Hispanic groups. In all the 3 groups, a shorter duration of U.S. residence was associated with lower odds of preterm birth. Further studies are needed to understand the biological and social determinants underlying these nativity-related disparities and the impact of acculturation.
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Affiliation(s)
- Yaa A Kwapong
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ellen Boakye
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Olufunmilayo H Obisesan
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lochan M Shah
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - S Michelle Ogunwole
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allison G Hays
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Roger S Blumenthal
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andreea A Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael J Blaha
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Miguel Cainzos-Achirica
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Khurram Nasir
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Pamela S Douglas
- Duke Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Garima Sharma
- The Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Wong ND, Budoff MJ, Ferdinand K, Graham IM, Michos ED, Reddy T, Shapiro MD, Toth PP. ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK ASSESSMENT: An American Society for Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol 2022; 10:100335. [PMID: 35342890 PMCID: PMC8943256 DOI: 10.1016/j.ajpc.2022.100335] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 01/08/2023] Open
Abstract
Risk for atherosclerotic cardiovascular disease (ASCVD) shows considerable heterogeneity both in generally healthy persons and in those with known ASCVD. The foundation of preventive cardiology begins with assessing baseline ASCVD risk using global risk scores based on standard office-based measures. Persons at low risk are generally recommended for lifestyle management only and those at highest risk are recommended for both lifestyle and pharmacologic therapy. Additional “risk enhancing” factors, including both traditional risk factors and novel biomarkers and inflammatory factors can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk. There are also female-specific risk enhancers, social determinants of health, and considerations for high-risk ethnic groups. Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies. Persons with pre-existing ASCVD also have variable risk, affected by the number of major ASCVD events, whether recurrent events have occurred recently, and the presence of other major risk factors or high-risk conditions. Current guidelines define high to very high risk ASCVD accordingly. Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk. Finally, the clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk is central to this process. This clinical practice statement provides the preventive cardiology specialist with guidance and tools for assessment of ASCVD risk with the goal of appropriately targeting treatment approaches for prevention of ASCVD events.
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Affiliation(s)
- Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, United States
- Corresponding author.
| | - Matthew J. Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Keith Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | - Ian M. Graham
- Department of Cardiology, Trinity College, Dublin, Ireland
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tina Reddy
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | | | - Peter P. Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- CGH Medical Center, Sterling, IL, United States
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Affiliation(s)
- Rachel M Bond
- Dignity Health, Arizona, Chandler (R.M.B.).,Division of Cardiology, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE (R.M.B.)
| | - Annette Ansong
- Division of Cardiology, Children's National Hospital, Washington, DC (A.A.)
| | - Michelle A Albert
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine (M.A.A.)
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DeFilippis EM, Walsh MN. Cardiovascular Outcomes of Severe Maternal Morbidity: Decades in the Making. Circ Cardiovasc Qual Outcomes 2022; 15:e008727. [PMID: 35098731 DOI: 10.1161/circoutcomes.121.008727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ogunniyi MO, Commodore-Mensah Y, Ferdinand KC. Race, Ethnicity, Hypertension, and Heart Disease: JACC Focus Seminar 1/9. J Am Coll Cardiol 2021; 78:2460-2470. [PMID: 34886968 DOI: 10.1016/j.jacc.2021.06.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
Hypertension is the leading cause of cardiovascular morbidity and mortality globally. In the United States, the prevalence of hypertension (blood pressure ≥130/80 mm Hg) among adults is approximately 45%. Racial/ethnic disparities in hypertension prevalence are well documented, especially among Black adults who are disproportionately affected and have one of the highest rates of hypertension globally. Hypertension control remains a persistent public health crisis. Recently published data indicate suboptimal hypertension control rates, particularly for racial/ethnic minority groups in the United States. This requires urgent action because of the significant health care burden from cardiovascular- and stroke-related morbidity and mortality. This clinical review delineates racial/ethnic disparities in the epidemiology of hypertension, and the impact of social determinants of health on the quality of cardiovascular care and outcomes. Clinical practice guideline recommendations and various national programs targeted toward hypertension control and proposed solutions to eliminate these disparities are discussed.
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Affiliation(s)
- Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA. https://twitter.com/modeldoc
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. https://twitter.com/ycommodore
| | - Keith C Ferdinand
- Tulane Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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Minhas AS, Boakye E, Obisesan OH, Kwapong YA, Zakaria S, Creanga AA, Vaught AJ, Mehta LS, Davis MB, Bello NA, Cainzos-Achirica M, Nasir K, Blaha MJ, Blumenthal RS, Douglas PS, Wang X, Sharma G. The Association of Preterm Birth With Maternal Nativity and Length of Residence Among Non-Hispanic Black Women. CJC Open 2021; 4:289-298. [PMID: 35386126 PMCID: PMC8978076 DOI: 10.1016/j.cjco.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Preterm birth (PTB) is associated with future cardiovascular disease (CVD) risk and disproportionally affects non-Hispanic Black (NHB) women. Limited data exist on the influence of length of US residence on nativity-related disparities in PTB. We examined PTB by maternal nativity (US born vs foreign born) and length of US residence among NHB women. Methods We analyzed data from 2699 NHB women (1607 US born; 1092 foreign born) in the Boston Birth Cohort, originally designed as a case-control study. Using multivariable logistic regression, we investigated the association of PTB with maternal nativity and length of US residence. Results In the total sample, 29.1% of women delivered preterm (31.4% and 25.6% among US born and foreign born, respectively). Compared with foreign born, US-born women were younger (25.8 vs 29.5 years), had higher prevalence of obesity (27.6% vs 19.6%), smoking (20.5% vs 4.9%), alcohol use (13.2% vs 7.4%), and moderate to severe stress (73.5% vs 59.4%) (all P < 0.001). Compared with US-born women, foreign-born women had lower odds of PTB after adjusting for sociodemographic characteristics, alcohol use, stress, parity, smoking, body mass index, chronic hypertension, and diabetes (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.65-0.97). Foreign-born NHB women with < 10 years of US residence had 43% lower odds of PTB compared with US-born (aOR, 0.57; 95% CI, 0.43-0.75), whereas those with ≥ 10 years of US residence did not differ significantly from US-born women in their odds of PTB (aOR, 0.76; 95% CI, 0.54-1.07). Conclusions The prevalence of CVD risk factors and proportion of women delivering preterm were lower in foreign-born than US-born NHB women. The "foreign-born advantage" was not observed with ≥ 10 years of US residence. Our study highlights the need to intensify public health efforts in exploring and addressing nativity-related disparities in PTB.
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Affiliation(s)
- Anum S. Minhas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Olufunmilayo H. Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yaa A. Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sammy Zakaria
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A. Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arthur J. Vaught
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Laxmi S. Mehta
- Division of Cardiology, the Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Melinda B. Davis
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Natalie A. Bello
- Division of Cardiology, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Miguel Cainzos-Achirica
- Houston Methodist Hospital and DeBakey Heart & Vascular Center, Center for Outcomes Research, Houston, Texas, USA
| | - Khurram Nasir
- Houston Methodist Hospital and DeBakey Heart & Vascular Center, Center for Outcomes Research, Houston, Texas, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pamela S. Douglas
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Corresponding author: Dr Garima Sharma, Johns Hopkins University School of Medicine–Ciccarone Center of Prevention of Cardiovascular Disease, 565 C Carnegie Building, 600 N Wolfe Street, Baltimore, Maryland 21287, USA.
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28
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Chavez P, Wolfe D, Bortnick AE. Management of Ischemic Heart Disease in Pregnancy. Curr Atheroscler Rep 2021; 23:52. [PMID: 34268620 PMCID: PMC8528181 DOI: 10.1007/s11883-021-00944-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is an escalating cause of maternal morbidity and mortality. Women are at risk for acute myocardial infarction (MI), and more are living with risk factors for ischemic heart disease (IHD). The purpose of this review is to describe the evaluation and management of women at risk for and diagnosed with IHD in pregnancy. RECENT FINDINGS Pregnancy can provoke MI which has been estimated as occurring in 1.5-10/100, 000 deliveries or 1/12,400 hospitalizations, with a high inpatient mortality rate of approximately 5-7%. An invasive strategy may or may not be preferred, but fetal radiation exposure is less of a concern in comparison to maternal mortality. Common medications used to treat IHD may be continued successfully during pregnancy and lactation, including aspirin, which has an emerging role in pregnancy to prevent preeclampsia, preterm labor, and maternal mortality. Hemodynamics can be modulated during pregnancy, labor, and postpartum to mitigate risk for acute decompensation in women with IHD. Cardiologists can successfully manage IHD in pregnancy with obstetric partners and should engage women in a lifetime of cardiovascular care.
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Affiliation(s)
- Patricia Chavez
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Diana Wolfe
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Obstetrics & Gynecology and Women's Health (Maternal Fetal Medicine), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.,Maternal Fetal Medicine & Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anna E Bortnick
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. .,Maternal Fetal Medicine & Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. .,Division of Geriatrics, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. .,Jack D. Weiler Hospital, 1825 Eastchester Road Suite 2S-46 Bronx, New York, NY, 10461, USA.
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Mocumbi AO. Women's cardiovascular health: shifting towards equity and justice. Lancet 2021; 397:2315-2317. [PMID: 34010612 DOI: 10.1016/s0140-6736(21)01017-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Olga Mocumbi
- Instituto Nacional de Saúde, Maputo, 1120 Mozambique; Universidade Eduardo Mondlane, Maputo 1101, Mozambique.
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30
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Afari HA, Davis EF, Sarma AA. Echocardiography for the Pregnant Heart. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:55. [PMID: 34075291 PMCID: PMC8160078 DOI: 10.1007/s11936-021-00930-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 01/22/2023]
Abstract
Purpose of review Pregnancy is associated with significant hemodynamic changes, making it a potentially high-risk period for women with underlying cardiovascular disease. Echocardiography remains the preferred modality for diagnosis and monitoring of pregnant women with cardiovascular disease as it is widely available and does not require radiation. This paper reviews the role of echocardiography along the continuum of pregnancy in at-risk patients, with a focus on key cardiac disease states in pregnancy. Recent findings In the preconception stage, risk stratification scores such as CARPREG II, ZAHARA and the modified WHO remain central to counseling and planning. As such, echocardiography serves an important role in assessing the severity of pre-existing structural disease. Among women with pre-existing cardiovascular disease who become pregnant-as well as those who develop cardiovascular symptoms during pregnancy-echocardiography is a key imaging tool for assessment of hemodynamic and structural changes and is recommended as the first-line imaging modality when appropriate by both the American College of Obstetricians and Gynecologists (ACOG) and the Food and Drug Administration (FDA). However, routine screening intervals during pregnancy for various cardiac lesions are not well defined, resulting in clinical heterogeneity in care. Summary Echocardiography is the imaging modality of choice for defining, risk stratifying, and monitoring cardiovascular changes throughout pregnancy. Once identified, at-risk patients should receive careful individual counseling and follow-up with a multidisciplinary team. Echocardiography serves as a widely available tool for serial monitoring of pregnant women with cardiovascular disease throughout pregnancy and the postpartum period.
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Affiliation(s)
| | - Esther F. Davis
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
| | - Amy A. Sarma
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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31
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Cortés YI, Breathett K. Addressing Inequities in Cardiovascular Disease and Maternal Health in Black Women. Circ Cardiovasc Qual Outcomes 2021; 14:e007742. [PMID: 33563006 PMCID: PMC7899716 DOI: 10.1161/circoutcomes.121.007742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Yamnia I Cortés
- School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC (Y.I.C.)
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ (K.B.)
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