Though preventable, maternal morbidity and mortality rates in the U.S. continue to be alarmingly high. With mental health conditions, anemia, cardiac disease and hypertension being the top causes of maternal mortality, over 80% of these deaths are preventable. There is an urgent need to lower these rates, which will require expertise and collaboration across various physician specialties.
“If we’re going to make a dent in maternal morbidity and mortality, it’s going to take the entire house of medicine,” according to Chapel Hill, North Carolina, ob-gyn Kavita Shah Arora, MD, MBE, MS, a presenter at an American College of Obstetricians and Gynecologists education session at the 2024 AMA Annual Meeting in Chicago.
“The leading cause of pregnancy-related deaths are mental health conditions, hemorrhage, cardiac and coronary conditions, and also include infection, embolism, thrombotic conditions, cardiomyopathy and hypertensive disorders of pregnancy,” said Dr. Arora, noting “these are not things that ob-gyns were classically trained or necessarily experts in.”
But “we can come together and work together and learn from each other’s expertise in order to provide better prenatal, pregnancy, and postpartum care,” she said.
Learn more about AMA advocacy to improve maternal health.
In the education session, panelists shared how physicians from many specialties can address maternal morbidity and mortality.
Address preeclampsia risk
“If you have a patient and you know they have risk factors for preeclampsia and they are less than 24 weeks, they really should be on a low dose of aspirin,” noted Nicole Lee Plenty, MD, MPH, MS, a maternal-fetal medicine physician in Atlanta, Georgia. “Even if it’s this person’s third baby, everyone needs to be put on low-dose aspirin.”
“As a body of medicine, we really do need to do a better job at putting people on aspirin for preeclampsia risk reduction because it really is the only thing that we have to reduce the risk of preeclampsia … which leads to bleeding, which leads to hemorrhaging,” said Dr. Plenty, who is also a delegate for the AMA Women Physicians Section. “Timeliness is going to be key to prevention of hemorrhage. Timeliness is going to be key to prevention of preeclampsia and death related to hypertensive disorders of pregnancy.”
Measure BP and act on it
Sometimes when a patient who is pregnant has high blood pressure, it may be brushed off as anxiety and as a result the recognition of preeclampsia is delayed or missed.
“The harm in not counting the blood pressure is that you have somebody like my cousin who was young and healthy,” but passed away from undiagnosed preeclampsia, Dr. Plenty said. “We don’t care if you are four weeks postpartum or if you are 22 weeks pregnant, count the blood pressure every time. There is no harm” in doing that.
Target: BP™️, a national initiative co-led by the AMA and American Heart Association, leverages the AMA MAP™ Hypertension program to help care teams organize their approach to providing evidence-based care and helps health care organizations improve and sustain BP control with professional education, practice tools, and resources.
Screen for perinatal mental health
One of the biggest concerns in maternal health “is mental health, so being able to screen for anxiety and depression makes a big difference,” said Athens, Georgia internist Theresa Rohr-Kirchgraber, MD, who noted that a federally funded collaborative, the Women’s Preventive Services Initiative, is an excellent resource for patients and physicians.
“Every time I see a patient in my primary care practice, I’m screening for anxiety, depression, smoking, blood pressure, personal violence—and a lot of this gets done before I even walk in the room,” said Dr. Rohr-Kirchgraber, at-large representative of the AMA Minority Affairs Section.
The rates are quite high for perinatal psychiatric disorders. For example, 14.5% have a new episode of depression during nine months of pregnancy or the first three months after birth.
While solutions are different at the structural and individual practice level, “training is really important,” said Dorothy Sit, MD, a psychiatrist in Chicago.
“It’s a way to plant seeds, build generations to become more informed in providing excellent care. … We can do so much with training and education,” said Dr. Sit, who recommended the American College of Obstetricians and Gynecologists’ perinatal mental health toolkit.
