Maternal cardiac disease is a leading cause of maternal mortality and morbidity in pregnancy and the first year postpartum.1,2 The most recent data suggests that cardiovascular diseases account for 26.5% of pregnancy-related deaths in the US.1 The North Carolina Maternal Mortality Review Committee found that cardiovascular conditions were the third leading cause of pregnancy-related deaths in North Carolina in 2018-2019.4 Of additional concern are the disparities in cardiovascular disease outcomes in the US, with higher rates of morbidity and mortality among non-White and lower-income women.1 In North Carolina from 2011-2018, non-Hispanic Black women had a severe maternal mortality rate 1.6 times the rate of non-Hispanic White women, including 2-3 times higher rates of cardiac, renal, and respiratory complications.6
Diagnosis of maternal cardiac disease can be challenging due to the overlap of cardiovascular symptoms with the normal physiologic changes of pregnancy.1 Maternal mortality reviews have found that most patients who die from pregnancy-related cardiovascular disease had undiagnosed or new-onset cardiovascular disease of pregnancy.1 Barriers to diagnosis and treatment include missed opportunities to identify cardiovascular disease risk factors during prenatal care, barriers to routine cardiac risk assessment, gaps in high-risk intrapartum care, and delays in recognizing cardiovascular disease symptoms postpartum.1
We at PQCNC will work with teams across the state to support the implementation of evidence-based measures to improve recognition and treatment of maternal cardiac conditions in North Carolina, including:
- Completing a cardiac risk assessment on 100% of obstetric patients.
- Ordering a cardiology consult on 100% of obstetric patients at high risk for cardiac morbidities.
References 1. Hollier LM, Martin JN, Connolly H, et al. ACOG Practice Bulletin No. 212: Pregnancy and Heart Disease. Obstetrics & Gynecology. 2019;133(5):e320-e356. doi:10.1097/AOG.0000000000003243 2. Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstetrics and Gynecology. 2015;125(1):5-12. doi:10.1097/AOG.0000000000000564 3. National Center for Health Statistics. Maternal Deaths and Mortality Rates by State, 2018-2022.; 2022. Accessed October 9, 2024. https://www.cdc.gov/nchs/maternal-mortality/mmr-2018-2022-state-data.pdf 4. Division of Public Health. North Carolina 2018-2019 Maternal Mortality Review Report.; 2024. Accessed October 9, 2024. https://wicws.dph.ncdhhs.gov/docs/MMRCReport.pdf 5. Moyett JM, Zambrano Guevara LM, Mallampati DP, et al. Racial and Rural-Urban Disparities in Maternal Cardiac Disease Care in North Carolina: A Call to Action. N C Med J. 2023;84(4):249-256. doi:https://doi.org/10.18043/001c.81277 6. Vladutiu C, Mallampati D, Jones-Vessey K, Menard K. Racial and ethnic disparities in severe maternal morbidity among delivery hospitalizations in North Carolina. Am J Obstet Gynecol. 2021;224(2, Supplement):S661.
