Addressing Maternal Cardiovascular Mortality: The Role of Policy in Reducing Preventable Deaths and Disparities

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.