Thread by @MGHHeartHealth

A brief ‘Tweetorial’ for cardiologists / anyone who cares for patients who are or might become pregnant 🤰

as all of us have an increasingly important role to play in reproductive health

🧵 👇

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In contrast with every other high-income country, maternal mortality has been rising in the U.S. for past 3 decades

and disproportionately affects Black women by 3- to 4-fold vs. White women

❗️70% of pregnancy-associated deaths are preventable❗️

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What does this have to do with cardiology?

Hypertension, cardiovascular conditions, and stroke together now account for roughly half of maternal deaths

Cardiomyopathy = leading cause of pregnancy-associated death between 6 weeks and 1 year postpartum

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Pre-conception risk assessment ‼️critical‼️ for our patients w/ 🫀 disease

Helpful risk classification systems include the CARPREG II score + WHO classification

Note that pregnancy is high-risk in mWHO class III + contraindicated in mWHO class IV

jacc.org/doi/10.1016/j.…

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Cardiologists should have plans for pregnancy in reproductive-aged individuals with heart disease

E.g., need to adjust 💊 for hypertension and cardiomyopathy, including ACEi/ARB/ARNI and MRA

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All of this underscores the importance of planning for 🤰 in high-risk individuals

and contraception to prevent unintended 🤰

Note: Barrier methods alone = not sufficiently effective

Long-acting reversible contraception (IUDs and implants) preferred in those w/ CVD

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This discussion also underscores the importance of multi-disciplinary care of pregnant individuals with cardiovascular disease #CardioObstetrics

CardioOB is a truly a team sport

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The “4th trimester” (early postpartum period) is esp high-risk for 👭 w/ 🫀 disease

At present, Medicaid for 🤰 care expires 60 d postpartum in 14 states, preventing high-risk women who lose coverage from transitioning to longitudinal 🏥 care

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To recap:
🔹Reproductive health is a cardiology issue
🔹Avoidance of unplanned pregnancy is 🔑 in those with 🫀 disease
🔹Those w/ 🫀 disease contemplating 🤰 should have pre-conception assessment + multi-disciplinary cardioOB mgmt
🔹Critical to continue care postpartum