A new ACC Expert Consensus Decision Pathway (ECDP) addressing "Optimization of Postpartum Care for Patients With and at Risk for Premature and Long-Term Cardiovascular (CV) Disease" provides recommended strategies for successful postpartum cardiovascular care, which should begin before birth and continue through the first year after delivery.

Published in JACC, the ECDP acknowledges the many barriers to care during the postpartum period, and emphasizes the importance of following a structured approach for optimized maternal CV health care that begins immediately after delivery and extends through the first year.

"The postpartum period is a critical opportunity to engage in collaborative patient care that is focused on improving short- and long-term cardiometabolic outcomes," said Kathryn J. Lindley, MD, FACC, chair of the ECDP writing committee and associate professor of medicine at Vanderbilt University Medical Center's Division of Cardiovascular Medicine. "Understanding and following a structured approach to the provision of postpartum care for all individuals with or at risk for CVD is a crucial first step toward eliminating excess maternal morbidity and mortality and reducing inequities."

The ECDP recommends comprehensive postpartum cardiovascular care visits, along with early outpatient follow up for cardiovascular symptom monitoring; effective management of postpartum cardiovascular emergencies; and non-cardiovascular aspects of care like lactation, mental health and contraception. It also recommends patient involvement in decision-making, along with early blood pressure management and cardiovascular symptom screening, plus comprehensive cardiovascular risk factor modification and "effective transition to longitudinal preventative care before the end of the first year after delivery."

Looking ahead, the authors note that "significant knowledge gaps remain" and urge continued research to better understand "optimal blood pressure goals, cardiometabolic screening timing and modality, implementation of lifestyle modification, and cardiovascular medication safety during breastfeeding. They also highlight the need for implementation research around how best to scale and sustain effective postpartum care models and underscore the importance of advocacy for policies that promote patient access to necessary CV care.

The ECDP was developed in collaboration with and is endorsed by the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.