Cardio-Obstetrics: A Critical Framework for Reducing Cardiovascular-related Maternal Mortality

Abstract Purpose of the Review To summarize the epidemiology of maternal cardiovascular morbidity and mortality and describe the structure and clinical applications of a multidisciplinary cardio-obstetrics team to prepare, recognize, and respond to maternal cardiovascular disease. Recent Findings Maternal mortality rates in the Unites States are higher than those of similarly industrialized nations. Among the causes, cardiovascular disease is the leading cause of maternal morbidity and mortality in the United States. This is attributed to increasing maternal comorbidities during pregnancy, increasing maternal age, previous survivors of surgically corrected congenital heart disease now reaching reproductive age, and persistent racial and geographic disparities. Recent evidence has demonstrated that aside from increasing risk of the pregnancy itself, cardiovascular disease during pregnancy and adverse pregnancy outcomes increase lifelong risk for cardiovascular disease. Thus pregnancy and postpartum are critical timepoints to recognize and respond to warning signs and symptoms. In response to the increasing incidence, the American Heart Association and the European Society of Cardiology have published updated guidelines to outline the multidisciplinary management of maternal cardiovascular disease. Additionally, there has been a nationwide push for the creation of multidisciplinary cardio-obstetrics teams, with publicly available implementation bundles to facilitate this. Summary With maternal cardiovascular disease on the rise and parallel increases in pregnancy-related cardiovascular morbidity and mortality, nationwide efforts should move toward universal screening for cardiovascular disease in pregnancy and the creation of multidisciplinary cardio-obstetrics teams to respond and manage pregnancies complicated by maternal cardiovascular disease.