A new report from the National Academies of Sciences, Engineering, and Medicine calls for "stronger clinical preventive services, better follow-up after delivery, and improved care coordination across the reproductive life course" to better manage cardiovascular disease risk in pregnant and postpartum patients and prevent pregnancy-related cardiovascular deaths in the U.S.

"Pregnancy can reveal cardiovascular risk that may not have been recognized before, but prevention cannot stop at delivery," said Tracy A. Lieu, MD, MPH, chair of the report's writing committee. "Too often opportunities are missed when care is fragmented, follow-up ends too early, or women are not connected to ongoing preventive care. We need to strengthen prevention and continuity of care before, during, and after pregnancy."

After reviewing nine clinical preventive services for maternal cardiovascular health, Lieu and colleagues highlight the following two recommendations with substantial evidence for improving care: 1) blood pressure targets in pregnant patients being treated for chronic hypertension should be <140/90 mm Hg to reduce the risk of severe-range hypertension, preeclampsia, medically indicated preterm birth and other adverse outcomes without compromising fetal growth; and 2) remote or self-measured blood pressure monitoring with structured clinical follow-up should be used to enhance postpartum hypertension management in patients with chronic high blood pressure or other hypertensive disorders of pregnancy.

The authors also suggest improving care access across the broader health care system could positively impact maternal health and outcomes, pointing to "maintaining continuity of insurance coverage, strengthening care transitions and care coordination, and expanding evidence-supported telehealth approaches." They also highlight other barriers to care, such as transportation, child care, time away from work, broadband access for telehealth, and fragmented systems of care, as opportunities for federal and state partners to intervene and provide support.

In an accompanying perspective article published in JAMA, Rachel M. Bond, MD, FACC, et al., write: "Programs supported by [the Health Resources and Services Administration], including community health centers, rural health care programs, and maternal health initiatives, play a crucial role in mitigating these barriers. When aligned with sustainable financing, interoperable data systems, and workforce capacity, these programs are well positioned to facilitate cardiovascular preventive services in pregnancy and the postpartum year and strengthen continuity of care."

One of ACC's advocacy priorities is to champion access to cardiovascular care for all, including patients who are pregnant or postpartum. Earlier this year, the College celebrated the passage of the Preventing Maternal Deaths Reauthorization Act and is working to advance several bills to improve maternal health nationwide, including the Connected Maternal Online Monitoring Act and the Rural Obstetrics Readiness Act. Take action with ACC Advocacy.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Hypertension

Keywords: ACC Advocacy, Health Services Accessibility, Maternal Health, Postpartum Period, Hypertension, Pregnancy-Induced, Pregnancy, Cardiovascular Diseases, Postprandial Period