Cardiovascular disease is now the leading cause of maternal mortality in the U.S., and rates of maternal morbidity and mortality continue to climb driven by preexisting heart conditions and risk factors linked to advancing maternal age.

To address this urgent challenge, the ACC's Cardio-Obstetrics Essentials: Team-Based Management of Cardiovascular Disease and Pregnancy, led by Course Chair Natalie Bello, MD, MPH, FACC, and Vice Chair Deirdre J. Mattina, MD, FACC, provided clinicians with an interprofessional deep dive into this evolving field. Held in October at ACC's Heart House headquarters in Washington, DC, and virtually, the course focused on equipping clinicians with strategies for better diagnosis, risk assessment, and treatment of patients of childbearing age. Key takeaways from the meeting include:

1. Maternal morbidity and mortality in the U.S. remain unacceptably high, with cardiovascular disease being a major contributor to adverse pregnancy outcomes. Combating the maternal health crisis will require expansion of pregnancy heart teams, addressing racial/ethnic disparities in care, and mandated insurance coverage for one year postpartum.
2. Technology can and should be utilized to improve access to care for pregnant and postpartum patients. Remote blood pressure monitoring, telehealth and electronic medical record (EMR) dashboards as well as shared medical appointments are among the options for leveraging out-of-hospital care.
3. Two risk stratification tools, mWHO 2.0 and CARPREG II, can help guide preconception counseling and pregnancy management of cardio-obstetric patients. However, it's important to keep in mind that while risk stratification is essential to informed decision-making, scores do not always accurately reflect risk in complex patients. An individualized, multidisciplinary approach should be employed for every patient.
4. Preconception counseling is critical for women with cardiovascular disease because it allows clinicians to assess risk, optimize heart health and develop individualized care plans before pregnancy. Preconception counseling should include discussions around:
   • Recommendations on gestational weight gain based on prepregnancy weight
   • Physical activity recommendations that are SMART (Specific, Measurable, Achievable, Relevant and Time-Bound)
   • Adherence to a Mediterranean-style diet
   • Use of aspirin for preeclampsia prophylaxis
   • Management of chronic hypertension in pregnancy to a goal <140/90 mmHg
5. Understanding hemodynamic shifts across pregnancy, delivery and postpartum is essential to minimize acute maternal decompensation, especially in patients with adult congenital heart disease. A well-crafted delivery plan agreed upon by the pregnancy heart team, including an anesthesiologist, should be documented in the EMR and include postdelivery monitoring specifications and contingencies.

Keywords: Cardiology Magazine, ACC Publications, Reproductive Health, Maternal Mortality, Cardio-Obstetrics, Pregnancy, Women