There is an unmet need for cardio-obstetrics training in cardiovascular disease fellowship programs, and training should be standardized to ensure all fellows in training have the necessary knowledge to treat and refer high-risk cardio-obstetrics patients, according to a JACC Scientific Statement published Oct. 23 in JACC.

Melinda B. Davis, MD, FACC, member of ACC’s Reproductive Health and Cardio-Obstetrics Member Section, et al., write that, although maternal mortality rates in the U.S. continue to increase, no standard curriculum for training to ensure a baseline level of knowledge in cardio-obstetrics has been developed. They note that “standards for accredited training in cardio-obstetrics are needed to improve the quality of education and ultimately the quality of care available in this field, and training in cardio-obstetrics should be addressed in the next revision of the Core Cardiovascular Training Statement.”

The authors review the core knowledge elements for a cardio-obstetrics training program, which include cardiovascular risk stratification and counseling; management during pregnancy; planning for labor and delivery; and post-partum follow-up.

The authors propose three levels of training, each including didactics, multidisciplinary patient care and at least one cardio-obstetrics scholarly activity. Level I would provide basic cardio-obstetrics training, as cardiologists across all specialties will need to care for pregnant patients. Level II would provide a higher level of knowledge and competence in cardio-obstetrics to enable cardiologists to provide autonomous focused care for pregnant patients in need of cardiovascular expertise. Level III would prepare cardiologists who intend to lead dedicated cardio-obstetrics programs and/or provide multidisciplinary care to patients at highest risk.

They also make recommendations regarding the assessment of competency, stating the need for “standardized testing of core competencies (Level I) should be included in the American Board of Internal Medicine Cardiovascular Diseases Certification and Recertification examinations.”

The authors write, “by standardizing training expectations, the field of cardio-obstetrics will ensure that cardiologists have the skills necessary to care for the growing population of patients with [cardiovascular] in the setting of pregnancy.”