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Cardiovascular Health in the Postpartum Period

To identify the key insights or developments described in this article
1 Credit CME

Maternal deaths (ie, during pregnancy or <42 days after delivery) have increased in the US in recent years, with 1205 maternal deaths reported in 2021. The resultant maternal mortality rate of 32.9 deaths per 100 000 live births is a significant increase from 20.1 in 2019.1 Additionally, significant disparities exist in maternal mortality, with 2- to 3-fold higher rates among American Indian/Alaska Native and non-Hispanic Black people compared with non-Hispanic White individuals. Approximately 80% of these deaths are preventable, with more than half occurring after delivery, which underscores the postpartum period as a critical time to monitor maternal health. Although the causes of maternal mortality are multifactorial, cardiovascular diseases (CVDs) are a major contributor. The prevalence of poor cardiovascular health (CVH) among individuals prior to pregnancy has increased significantly with less than half of individuals entering pregnancy with favorable CVH.2 Further, adverse pregnancy outcomes (APOs; hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age birth) complicate more than 1 in 5 live births in the US, are markers of poor CVH, and are associated with higher lifetime risk of CVD. The first year postpartum provides an opportunity for clinicians to measure, modify, and monitor CVH. Specific recommendations are listed in the Table.

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Article Information

Corresponding Author: Sadiya S. Khan, MD, MSc, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Dr, Ste 1400, Chicago, IL 60611 (s-khan-1@northwestern.edu).

Published Online: November 15, 2023. doi:10.1001/jama.2023.19192

Conflict of Interest Disclosures: Dr Khan reported grants from the National Institutes of Health (R01HL161514) during the conduct of the study and outside the submitted work (HL159250 and U01HL160279). No others were reported.

References
1.
Harris  E .  US maternal mortality continues to worsen.   JAMA. 2023;329(15):1248-1248.PubMedGoogle Scholar
2.
Khan  SS , Brewer  LC , Canobbio  MM ,  et al.  Optimizing prepregnancy cardiovascular health to improve outcomes in pregnant and postpartum individuals and offspring.   Circulation. 2023;147(7):e76-e91.PubMedGoogle ScholarCrossref
3.
Haas  DM , Parker  CB , Marsh  DJ ,  et al.  Association of adverse pregnancy outcomes with hypertension 2 to 7 years postpartum.   J Am Heart Assoc. 2019;8(19):e013092.PubMedGoogle Scholar
4.
Lloyd-Jones  DM , Allen  NB , Anderson  CAM ,  et al.  Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health.   Circulation. 2022;146(5):e18-e43.PubMedGoogle ScholarCrossref
5.
Vounzoulaki  E , Khunti  K , Abner  SC ,  et al.  Progression to type 2 diabetes in women with a known history of gestational diabetes.   BMJ. 2020;369:m1361.PubMedGoogle Scholar
6.
Cameron  NA , Yee  LM , Dolan  BM ,  et al.  Trends in cardiovascular health counseling among postpartum individuals.   JAMA. 2023;330(4):359-367.PubMedGoogle ScholarCrossref
7.
US Preventive Services Task Force.  Behavioral counseling to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors.   JAMA. 2020;324(20):2076-2094.PubMedGoogle ScholarCrossref
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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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