Cardiovascular-Related Maternal Mortality

Cardiovascular disease (CVD) is the leading cause of pregnancy-related death in the United States and disproportionately affects Black women. In this review, we address the major contributors to cardiovascular-related maternal deaths, focusing on the importance of both preconception and postpartum care. Risk factors such as hypertension, diabetes, dyslipidemia, and obesity contribute to cardiovascular risk during and after pregnancy. As prepregnancy optimization of these factors has been shown to mitigate this risk, we discuss evidence-based approaches to cardiovascular risk management in reproductive-aged women. Women with pre-existing CVD should undergo preconception counseling and risk assessment using validated tools such as the modified World Health Organization 2.0 classification. We review common presenting symptoms of CVD in pregnancy, such as shortness of breath, and we discuss how tools such N-terminal pro-B-type natriuretic peptide testing can help distinguish dyspnea of pregnancy from symptoms of heart failure. We also review the evidence-based management of the leading causes of cardiovascular-related maternal deaths, including cardiomyopathy, myocardial infarction, and hypertensive disorders of pregnancy. Importantly, the implementation of standardized care, such as perinatal CVD risk assessment algorithms, and postpartum remote monitoring programs may improve disparities in cardiovascular risk assessment and diagnosis.