Research key to addressing dismal U.S. maternal mortality rates

During Black Maternal Health Week, and in preparation for Women’s Health Month in May, researchers are sharing studies designed to help new and expecting parents before, during, and after pregnancy

WHAT: During Black Maternal Health Week, April 11-17, and in preparation for Women’s Health Month in May, researchers are raising awareness about pregnancy-related complications that disproportionately affect Black people. For instance, Black people are three times as likely to die from pregnancy and childbirth compared to white people. Studies also show that Black people are 2-4-times more likely to experience a hypertensive pregnancy-related complication, including death, compared to white people.

WHY HEART HEALTH: Optimal heart health is important at every stage of life, but especially during pregnancy and can provide a protective effect against pregnancy complications and for developing heart disease later in life. Recent research has shown that about half of people have at least one risk factor for heart disease, such as high blood pressure, diabetes, or being overweight, before pregnancy.

WHO: Researchers from the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), are available to discuss trends in maternal health research and programs created to support people before, during, and after pregnancy.   

THE RESEARCH  
   
Pregnancy as a window into future cardiovascular health    
   
For every 10 people who are pregnant, about 1-2 experience a complication. Half of pregnancy complications relate to having high blood pressure. Examples include preeclampsia, a sudden rise in blood pressure that can turn dangerous; gestational diabetes; and having a preterm birth. These types of complications, also referred to as adverse pregnancy outcomes, are now considered independent risk factors for cardiovascular disease.   
 
Preventing and managing cardiovascular disease risk factors is always important, but especially during pregnancy. For example, research has shown that people who experience a severe pregnancy complication related to high blood pressure have an increased risk for developing hypertension 2-7 years after giving birth, as well as for developing heart disease later in life.  

Other studies have even linked hypertensive-related pregnancy complications to accelerated cardiovascular aging. In these cases, hypertension and diabetes have been diagnosed a decade earlier in women who have experienced hypertensive-related pregnancy complications, compared to people who have not. These trends help explain why researchers refer to pregnancy as a window into future cardiovascular health.   
   
Powering physician-patient partnerships   

People considering pregnancy should talk to their doctor about their overall health and possible risks for pregnancy complications. This may include coming up with a plan to support cardiovascular health before, during, and after pregnancy.  
 
For example, recent research published in the New England Journal of Medicine found that people treated for chronic hypertension in pregnancy, which affects about 2% of the population, benefitted from early treatment. Compared to people who did not receive medication to lower their blood pressure below 140/90 mm Hg, those who did were less likely to experience certain complications, such as preeclampsia or a preterm birth.  
 
And in papers published in JAMA and Circulation Research, researchers describe best care practices for severe pregnancy complications. For example, adults should receive cardiology screenings three months after giving birth and then annually if they experienced an adverse pregnancy outcome. They should also receive routine risk assessments for heart disease and multidisciplinary support, if needed, from a team of specialists. Social factors, such as access to care, should also be factored into ongoing medical care and support.   
   
Studying health disparities and social determinants of health   
   
Maternal health disparities are staggering and a central part of maternal health research. Studies continue to show that American Indian, Asian, Black, Hispanic, and Pacific Islander women are more likely to experience a variety of adverse pregnancy outcomes. 

Multiple factors contribute to maternal health disparities – from health inequities and structural racism to inequities in the environments where people live, work and play, often called social determinants of health.  

As part of NHLBI’s nuMoM2b Heart Health Study, researchers are also studying links between social factors that correlate with the future heart health of new parents. After analyzing the health outcomes of more than 4,000 first-time parents, they found health literacy, socioeconomic status, and having social support, were connected to future cardiovascular health outcomes assessed several years after pregnancy.   
   
Bringing cardiovascular care to communities   

To address pregnancy-related health disparities, researchers at NHLBI are supporting multiple programs designed to help people before, during, and after pregnancy.   

The Maternal Health Community Implementation Project (CIP) is a community-driven initiative studying how evidence-based interventions, such as regular blood pressure readings, may help people before and during pregnancy.  

The Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH) is another community-focused initiative that engages the community to bring cardiovascular care to new parents and their children.   

The Randomized Evaluation of Bromocriptine in Myocardial Recovery Therapy (REBIRTH) for Peripartum Cardiomyopathy is a clinical research trial that started recently in the U.S. and Canada to see if bromocriptine therapy, a treatment used for diabetes and menstrual cramps, may help people diagnosed with peripartum cardiomyopathy. This is a condition marked by an enlargement and thickening of the heart, and it can occur between late pregnancy and shortly after giving birth.   

Through the newly published Chronic Hypertension and Pregnancy (CHAP) trial, researchers found blood pressure-lowering medications reduced the risk of severe pregnancy complications among adults with chronic hypertension in pregnancy. They will soon study long-term cardiovascular health outcomes among a subset of study participants and their children.
   
EXPERTS: Researchers in the Division of Cardiovascular Sciences (DCVS) and the Center for Translation Research and Implementation Science (CTRIS) at NHLBI are available to discuss these programs and ongoing maternal health research.   

Victoria Pemberton, R.N.C., program officer in DCVS’ Heart Development and Structural Diseases branch, and Jasmina Varagic, Ph.D., program officer in DCVS’ Vascular Biology and Hypertension branch, lead the nuMoM2b Heart Health Study. They are also part of the NIH maternal morbidity and mortality task force.  
 
Patrice Desvigne-Nickens, M.D., a medical officer within DCVS’ Heart Failure and Arrhythmias branch, guides REBIRTH and specializes in health disparities and clinical trials.  
 
Charlotte Pratt, Ph.D., R.D, the deputy branch chief in DCVS’ Clinical Applications and Prevention branch, is the scientific program officer for ENRICH and specializes in nutrition and in supporting cardiovascular health throughout the lifespan.   

Dave Clark, Dr.P.H., the branch chief in CTRIS’ Implementation Science Branch, is the scientific program lead Scientific Program Lead for (CIP) and specializes in implementation science and behavioral sciences. 

CONTACT: To request an interview with an NHLBI researcher, please email nhlbi_news@nhlbi.nih.gov.