New clinical guidelines outline strategies to improve postpartum cardiovascular care

A new Expert Consensus Decision Pathway by the American College of Cardiology (ACC) provides recommended strategies for improving postpartum care for individuals with and at risk for short- and long-term cardiovascular disease (CVD). The clinical document guides postpartum maternal cardiovascular (CV) health, recommending comprehensive postpartum cardiovascular care visits; early outpatient follow up for CV symptom monitoring; effective management of postpartum CV emergencies; and noncardiovascular aspects of care like lactation, mental health and contraception. The report published online today in JACC, the flagship journal of the ACC.

More than half of pregnancy-related deaths occur after the birth of an infant, and the risk of death rises substantially in the early postpartum period, especially the first two weeks postpartum. Individuals with the greatest risk include those with risk factors such as hypertension, obesity and dyslipidemia, as well as risk enhancers like gestational diabetes, hypertensive disorders of pregnancy and preterm birth.

The postpartum period is a critical opportunity to engage in collaborative patient care that is focused on improving short- and long-term cardiometabolic outcomes. Understanding and following a structured approach to the provision of postpartum care for all individuals with or at risk for CVD is a crucial first step toward eliminating excess maternal morbidity and mortality and reducing inequities."

Kathryn J. Lindley, MD, FACC, chair of the ECDP writing committee and associate professor of medicine at Vanderbilt University Medical Center's Division of Cardiovascular Medicine

The clinical document acknowledges the many barriers to care during the postpartum period and emphasizes the importance of following a structured approach for optimized maternal CV health care that begins immediately after delivery and extends through the first year.

Recommended postpartum maternal CV health care includes early blood pressure management and CV symptom screening, comprehensive CV risk factor modification and effective transition to longitudinal preventative care before the end of the first year after delivery.

The document is a report of the American College of Cardiology Solution Set Oversight Committee and was developed in collaboration with and is endorsed by the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.