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Postpartum Care Visits Underdeliver on Heart Health Counseling

Although about 90 percent of US women attend a postpartum visit, a new report shows that heart health counseling is lacking for 40 percent of at-risk women.

Many new mothers are being left vulnerable to poor heart health.

A Northwestern Medicine study revealed that despite being at risk for heart disease, a mere 60 percent of new mothers are receiving heart health counseling as part of their postpartum care.

Maternal mortality, defined as deaths during childbirth or within one year postpartum, has shown a disturbing rise in recent years.

Despite national efforts to reduce it, the number of maternal deaths rose to 1,205 in 2021. This translates to a maternal mortality rate of 32.9 per 100,000 live births, a significant rise from the rate of 23.8 in 2020.

Among the common causes are mental health conditions, hemorrhages, cardiac and coronary conditions, blood clots, cardiomyopathy, and hypertensive disorders. However, heart disease and stroke have emerged as leading causes of maternal mortality, with cardiomyopathy being the most common cause of death one week to a year after delivery.

According to the Centers for Disease Control and Prevention, more than half of US maternal deaths that occur between six weeks and a year postpartum are due to cardiovascular disorders.

Postpartum visits can be crucial for checking a mom’s heart health after delivery, study authors stated.

This Northwestern Medicine study discovered an upward trend in the prevalence of heart disease risk factors, such as being overweight, diabetes, high blood pressure, and preterm delivery, among birthing adults between 2016 and 2020.

With around 90 percent of women in the US attending at least one postpartum visit, researchers are calling for this “fourth-trimester” appointment to be leveraged for more heart health counseling.

For many already grappling with new responsibilities of motherhood and work, this visit represents a rare opportunity during the first-year post-pregnancy to focus on their own health, the study authors said.

“We need to find ways to take advantage of this prime opportunity when we have a captive audience of people who are already in the doctor’s office, talking about their health at a critical juncture in life,” corresponding author Sadiya Khan, MD, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine, said in a press release.

“It is hard to create new opportunities. The fourth-trimester visit is an already-ready moment to prioritize maternal heart health,” said Khan who is also a Northwestern Medicine physician.

Bridging the current counseling gap is essential, as highlighted by Natalie Cameron, the study's lead author.

“Our data show that reports of overall counseling are low. For people who have risk factors, lifestyle counseling during this critical time is a first step to reducing long-term risk of heart disease,” said Cameron, instructor of general internal medicine at Feinberg and a Northwestern Medicine physician. 

Khan made note that engaging patients in heart health counseling is key. While more women may have received counseling, only 60 percent of women reported remembering that they received counseling on how to optimize their heart health, Khan said. 

“I think it’s important that we also prioritize implementation science research that identifies the best strategies for counseling to improve heart health, particularly in the first year after pregnancy,” Khan said. “If counseling is provided but they don’t remember it or it does not translate into improvements in heart health, it’s not very effective.” 

Structural changes are also crucial. Khan underscored the necessity for healthcare systems and policies to better support women transitioning from pregnancy to postpartum.

Meanwhile, Cameron advocated for extending postpartum Medicaid coverage from 60 days to a full year, a move that would directly benefit over 40 percent of women who are insured by Medicaid during pregnancy.

As the crisis of maternal mortality rates continues to garner national attention, these proposed systemic changes and improved counseling practices could become pivotal in safeguarding the health of new mothers.

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