As a high-risk obstetrician and cardiologist, I’m with my patients and their families on some of their most joyful days. But their happiness is often balanced with fear. 

I lead the cardio-obstetrics program at a university health system with a comprehensive medical team. We manage pregnancies complicated by heart disease. Even with advanced health care, the U.S. has the highest maternal mortality rate among developed countries. Cardiovascular disease continues to be the leading cause of maternal deaths.

Cardiovascular conditions contribute to one-quarter of maternal deaths, according to the Centers for Disease Control and Prevention. A recent CDC report cited an alarming increase in maternal deaths from 23.8 per 100,000 births in 2020 to 32.9 a year later. Significant ethnic disparities also exist, with Black patient maternal deaths at 69.9 per 100,000 live births, a risk that is 2.6 times greater than white patients. Among Latinas, the mortality rate increased from 12.6 to 28 per 100,000 live births from 2019 to 2021, with the highest risk among women ages 40 and older.

Why is this happening?

Diagnosing cardiovascular disease during pregnancy is challenging because its symptoms mimic those experienced during a normal pregnancy. Nevertheless, we know that conditions like preeclampsia, gestational hypertension and cardiovascular issues can develop during pregnancy, putting women at higher risk for life-threatening complications.

For people with existing cardiovascular conditions such as heart failure, arrhythmias and cardiomyopathy, symptoms are often exacerbated during pregnancy, labor and delivery, and postpartum, making heart disease a critical factor in maternal health.

What can be done to prevent these deaths?

Our group published a study in the Journal of American College of Cardiology that outlines solutions to prevent cardiovascular complications during pregnancies. The study recommends screening pregnant patients for cardiac conditions in all care settings as a key step to lowering cardiovascular-related maternal mortality.

A universal cardiovascular disease risk assessment should be the standard of care for all who are planning a pregnancy, or who are pregnant or postpartum. This approach may identify increased cardiovascular risk, or uncover previously undiagnosed cardiac disease during pregnancy and the postpartum period. 

Cardiac risk assessments and preconception counseling haven’t kept pace with the crisis. Since 2012, more than 56 California hospitals have closed their maternity units. Many of these closures disproportionately affect Southern California communities of color.

Caring for patients with undetected cardiovascular disease during pregnancy and postpartum is expensive. The annual median cost for heart failure care in the U.S. is estimated at $24,383 per patient, with hospitalization being the primary driver of this expense, according to a 2020 study.

Recommendations for physicians and policymakers

Here are crucial steps we can take as physicians and health care policymakers to address this crisis. These recommendations are included the California Maternal Care Quality Collaborative and the Cardiac Conditions in Obstetrical Care Bundle by Alliance for Innovation on Maternal Health, which co-authored based on my research:

• Recognize that thorough prenatal care is essential to identify and manage heart disease risk factors early in a pregnancy.
• Ensure that women with cardiovascular conditions receive pre-pregnancy counseling and close monitoring throughout their pregnancy to reduce risks.
• Recognize that postpartum care, especially for those diagnosed with preeclampsia or gestational diabetes, is critical for reducing long-term cardiovascular risks.
• Develop telemedicine programs to support community health physicians in managing high-risk maternal fetal cases.

Our research focuses on a cardiovascular disease risk assessment algorithm that I helped develop. It’s now being validated in health systems across the country. My hope is that this risk assessment tool becomes the screening standard for all pregnancies to improve maternal and neonatal outcomes.

Through policy initiatives and increased community health care awareness, we can reduce U.S. maternal mortality rates and save women’s lives.

Dr. Afshan B. Hameed is a board-certified UCI Health cardiologist and maternal-fetal medicine specialist and a professor at the UC Irvine School of Medicine.