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Importance of the Cardio-Obstetrics Team

  • Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose

In the USA, maternal mortality has been rising since the 1980s. Cardiovascular disease is recognized as the leading cause of this worrisome trend, and a multidisciplinary approach to the care of patients with cardiovascular conditions during pregnancy is becoming increasingly important. We outline the literature supporting this multidisciplinary approach, highlight our center’s experience in building and expanding an integrated cardio-obstetrics practice, and provide guidance regarding patient selection and management within a combined practice.

Summary

Antenatal management patterns and delivery planning for patients with cardiovascular disease during pregnancy vary substantially among cardiovascular and obstetric and maternal fetal medicine practices in the USA. The need for multidisciplinary care between cardiologists and obstetricians is evident and has been supported by best practice statements from the American Heart Association, the American College of Obstetrics and Gynecology, and the Cardiac Disease in Pregnancy Study (CARPREG) investigators, whose CARPREG II risk score included “late first antenatal visit” as a predictor of adverse outcomes of pregnancy.

Conclusions

We have solid evidence supporting a multidisciplinary approach to the care of patients with cardiac conditions in pregnancy. This approach is optimal because it facilitates a consistent and clear message to the patient (and those caring for each patient) regarding management and risks associated with pregnancy, as well as subsequent risk and postpartum follow-up. We support the extension of clinical collaboration between obstetricians and cardiologists to the research realm and know that working together to investigate the outcomes of moms with heart conditions and their babies will provide clinically meaningful information to support the care of these unique patients.

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References and Recommended Reading

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  2. Wolfe DS, Hameed AB, Taub CC, Zaidi AN, Bortnick AE. Addressing maternal mortality: the pregnant cardiac patient. Am J Obstet Gynecol. 2019;220(2):167.e161–8.

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  4. Ramage K, Grabowska K, Silversides C, Quan H, Metcalfe A. Association of adult congenital heart disease with pregnancy, maternal, and neonatal outcomes. JAMA Netw Open. 2019;2(5):e193667.

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  6. Silversides CK, Grewal J, Mason J, Sermer M, Kiess M, Rychel V, et al. Pregnancy outcomes in women with heart disease: the CARPREG II study. J Am Coll Cardiol. 2018;71(21):2419–30.

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  8. Brown HL, Warner JJ, Gianos E, Gulati M, Hill AJ, Hollier LM, et al. Promoting risk identification and reduction of cardiovascular disease in women through collaboration with obstetricians and gynecologists: a presidential advisory from the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation. 2018;137(24):e843–52.

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Authors and Affiliations

  1. Saint Luke’s Health System, Kansas City, MO, USA

    Anna Grodzinsky MD MS, Karen Florio DO, John A. Spertus MD MPH, Tara Daming MD, John Lee MD, Valerie Rader MD, Lynne Nelson APRN, Rebecca Gray RN, Darcy White RN, Kate Swearingen APRN, Merrill Thomas MD, Annapoorna Singh MD, Anthony Magalski MD & Laura Schmidt MD

  2. University of Missouri–Kansas City, Kansas City, MO, USA

    Anna Grodzinsky MD MS, Karen Florio DO, John A. Spertus MD MPH, Tara Daming MD, John Lee MD, Valerie Rader MD, Lynne Nelson APRN, Rebecca Gray RN, Darcy White RN, Kate Swearingen APRN, Merrill Thomas MD, Annapoorna Singh MD, Anthony Magalski MD & Laura Schmidt MD

Authors
  1. Anna Grodzinsky MD MS
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  2. Karen Florio DO
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  3. John A. Spertus MD MPH
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  4. Tara Daming MD
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  5. John Lee MD
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  6. Valerie Rader MD
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  7. Lynne Nelson APRN
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  8. Rebecca Gray RN
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  9. Darcy White RN
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  10. Kate Swearingen APRN
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  11. Merrill Thomas MD
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  12. Annapoorna Singh MD
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  13. Anthony Magalski MD
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  14. Laura Schmidt MD
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Corresponding author

Correspondence to Anna Grodzinsky MD MS.

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Conflict of Interest

Anna Grodzinsky, Karen Florio, John A. Spertus, Tara Daming, John Lee, Valerie Rader, Lynne Nelson, Rebecca Gray, Darcy White, Kate Swearingen, Merrill Thomas, Annapoorna Singh, Anthony Magalski, and Laura Schmidt each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pregnancy and Cardiovascular Disease

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Grodzinsky, A., Florio, K., Spertus, J.A. et al. Importance of the Cardio-Obstetrics Team. Curr Treat Options Cardio Med 21, 84 (2019). https://doi.org/10.1007/s11936-019-0789-1

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  • DOI: https://doi.org/10.1007/s11936-019-0789-1

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