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
🧵 👇
1/9
as all of us have an increasingly important role to play in reproductive health
🧵 👇
1/9
2/9
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❗️
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❗️
3/9
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
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
4/9
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.…
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.…
5/9
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
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
6/9
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
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
7/9
This discussion also underscores the importance of multi-disciplinary care of pregnant individuals with cardiovascular disease #CardioObstetrics
CardioOB is a truly a team sport
This discussion also underscores the importance of multi-disciplinary care of pregnant individuals with cardiovascular disease #CardioObstetrics
CardioOB is a truly a team sport
8/9
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
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
9/9:
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
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
• • •
Missing some Tweet in this thread? You can try to
force a refresh
