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Cardiovascular Disease in Pregnancy

According to the Centers for Disease Control and Prevention (CDC), cardiovascular disease accounts for 15.2 percent of maternal mortality, making it the leading cause of maternal deaths. In a study of 257 pregnancy related deaths in California, researchers found that 64 were linked to cardiovascular disease. Among these pregnancy related deaths, 42 cases were classified as cardiomyopathy and 22 were classified as other cardiovascular. Among the cardiomyopathy cases, 69 percent (n=29) were related to dilated cardiomyopathy, 24 percent (n=10) were related to hypertrophic heart disease, and 7 percent (n=3) could not be determined.

The other cardiovascular disease cases in the CA-PAMR findings included the following subtypes:

  • Pulmonary hypertension (n=7)
  • Aortic dissection (n=5)
  • Unexplained sudden death (n=3)
  • Non-Valvular, congenital (n=3)
  • Coronary artery disease (n=2)
  • Valvular disease (n=2)

There are a number of risk factors in pregnant and post-partum women that increase the likelihood that a mother will develop cardiovascular disease-related complications. Among these factors, race is the most significant, as African American women are eight times more likely to die of cardiovascular disease-related complications than are their white counterparts. Other risk factors to consider include hypertension, diabetes, age greater than 30, BMI >35 and multifetal gestation.

Improvement activities related to cardiovascular disease in pregnancy should span the entire care continuum. This would begin with the prevention of modifiable risk factors (i.e., obesity) and the management of chronic diseases such as diabetes and hypertension. In addition, there is a need for improved screening during the prenatal, intrapartum and postpartum periods to assess for risk factors and detect complications as early as possible.

There are a variety of resources listed below to assist those interested in learning more about cardiovascular disease in pregnancy, including a link to the CMQCC toolkit on Improving Health Care Response to Cardiovascular Disease in Pregnancy and Postpartum. The toolkit includes resources related to racial and ethnic disparities, screening and risk stratification, and cardiovascular medications in the context of pregnancy and breastfeeding. In addition, CHPSO members are invited to register for an upcoming safe table meeting on cardiovascular disease in pregnancy on February 13, 2019. Click here for more information and to register for the safe table. Click here to see if your facility is a CHPSO member.

References and Resources

Hameed, A. B., Lawton, E. S., McCain, C. L., Morton, C. H., Mitchell, C., Main, E. K., & Foster, E. (2015). Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy. American journal of obstetrics and gynecology, 213(3), 379-e1. Available here.

Julie Vasher, D. N. P. Cardiovascular Disease in Pregnancy & Peripartum Cardiomyopathy. Available here.