To improve maternal health, the report says start before pregnancy

News from the American Heart Association

MONDAY, Feb. 13, 2023 (American Heart Association News) — The health of a woman’s heart before she becomes pregnant has a major impact on her risk of pregnancy-related complications and the long-term cardiovascular health of both mother and child, according to a new study. new report calling for more attention to the problem.

Improving maternal heart health during this critical period could help break the generational cycle of poor cardiovascular health, which has become a growing problem in the US, especially among women whose health is compromised by structural racism and other adverse social conditions, according to a new American Heart Scientific Statement from the association published Monday in Circulation.

“If you optimize the mother’s health before pregnancy, that optimizes her health during pregnancy, which affects the health of the child later in life,” said Dr. Holly Gooding, Vice Chair of the Statement Writing Committee. Gooding is the medical director of pediatrics at Children’s Healthcare in Atlanta and an associate professor in the department of pediatrics at Emory University in Atlanta.

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Cardiovascular disease is responsible for more than 1 in 4 pregnancy-related deaths in the US, and pregnancy-related complications are on the rise, according to the report. Almost 1 in 5 pregnancies are complicated by high blood pressure, gestational diabetes, premature birth or low birth weight. High blood pressure conditions such as preeclampsia and eclampsia have nearly doubled in the past decade. These types of adverse pregnancy outcomes have been shown to increase the risk of cardiovascular disease later in life for both mother and child.

Studies show that black women are disproportionately affected. With the number of pregnancy-related deaths rising in the US, black women are three times more likely to die from pregnancy-related complications than white women.

“This statement looks upstream at what the potential contributors to that rising burden may be,” said Dr. Sadiya Khan, writing committee chair and assistant professor of medicine at Northwestern University Feinberg School of Medicine in Chicago.

The new AHA report summarizes the current evidence linking a woman’s heart risk factors before and between pregnancies to pregnancy-related complications and the subsequent cardiovascular health of mother and child. It calls for exploring more ways to improve women’s health during the childbearing years, starting in early childhood. And it highlights the need for policy-level change to dismantle structural racism and other adverse social factors that create barriers to better maternal health.

“It’s critical to find ways to intervene and promote health in an equitable way,” Khan said.

A 2021 AHA scientific statement addressed the cardiovascular health of pregnant and postpartum women. The new statement focuses on a woman’s health before she becomes pregnant and in between pregnancies.

Because a woman can become pregnant unexpectedly, the writing committee chose to define pre-pregnancy broadly as any time during her childbearing years, Gooding said. For most women, that period is between 15 and 44 years, although it varies from person to person.

“We purposely avoided it because that’s something that further research needs to explore,” Khan said. “When is the appropriate time prior to pregnancy to intervene? At the population and public health level, we want to take a life-course perspective on this, start by focusing on prioritizing cardiovascular health the moment a person reaches the reproductive age.”

The best way to achieve good heart health — at any age — is to follow the key health measures and behaviors outlined in AHA’s Life’s Essential 8, Khan said. These include not smoking, getting enough sleep and exercise, maintaining a healthy weight, following a healthy diet, and controlling blood pressure, blood glucose, and cholesterol levels.

But the responsibility of helping women achieve those goals should include health care professionals and policymakers, she said. It is crucial to ensure that women have access to primary care throughout their lives, including before they want to become pregnant, and that they have access to insurance policies that cover pregnancy prevention and pregnancy-related care. It’s also important to have enough doctors to see them and make sure their cardiovascular risk factors are monitored.

“It’s a natural conclusion to say that we should all prioritize cardiovascular health, but it’s important that we don’t place the responsibility solely on the individual,” Khan said.

The statement says that future research should focus on finding evidence-based strategies to reduce maternal health risks and how such strategies could reduce the burden of cardiovascular disease more broadly.

Khan said some of this work has already begun.

She is a co-investigator in the AHA’s Health Equity Research Network on Disparities in Maternal-Infant Health Outcomes, which explores innovative and cost-effective strategies for improving access to health information and care before, during, and after pregnancy for Black and Native Americans. women and people living in rural areas.

In 2021, the federal Office of Minority Health launched a free e-learning program to build maternal health professionals’ knowledge and skills related to cultural competence. And last year, the White House released a blueprint for addressing maternal health, which includes efforts to strengthen economic and social support for women before, during and after pregnancy. It also includes programs to lower high blood pressure for Native Americans and veterans of childbearing age.

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or owned by the American Heart Association, Inc., and all rights are reserved. If you have any questions or comments about this story, please email [email protected]

By Laura Williamson, American Heart Association News

To improve maternal health, the report says start before pregnancy

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