Credit: Original article published here.
The 2023 American College of Cardiology Scientific Sessions in New Orleans was one that celebrated the inaugural section meeting for the newly created Reproductive Health & Cardio-Obstetrics Member Section. It simultaneously shone a light on the seismic shift that occurred in the United States for the cardiovascular care of pregnant persons with the US Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling. The ruling vacated the federal right to an abortion established by Roe v. Wade, returning the legality of abortion to the states. This decision, in an instant, eliminated the ability for millions of patients to receive comprehensive and safe reproductive counseling and care. As the number of pregnant patients and patients of child-bearing age with cardiovascular disease continues to climb, “Cardiovascular Care of Women in the Post-Dobbs Era” was an essential and timely topic for a panel discussion at ACC 2023. Moderated by Dr. Malissa Wood, the discussion focused on the strategies and models of care providers, both in cardiology and obstetrics, must take on to fully care for our patients with cardiovascular disease who are of child-bearing age.
The panel emphasized several key topics surrounding the care of these patients: pre-conception counseling, pregnancy termination, and the safety of patients and physicians. While preconception counseling should serve as a cornerstone for cardio-obstetrics care, for patients and providers residing in states where pregnancy termination is now illegal, it becomes even more paramount. Preconception counseling that encompasses education regarding risks associated with pregnancy, assistance with optimization of health prior to pregnancy, and contraception planning can be lifesaving. As Dr. Shelley Hall put it, “birth control is GDMT” in our cardiovascular patients of reproductive age, giving patients control of their reproductive and cardiovascular health.
Maternal mortality continues to climb in the United States and cardiovascular disease has been attributed to 26% of those deaths.2 For patients with pulmonary hypertension, left ventricular dysfunction, valvular disorders, and aortopathy to name just a few, maternal mortality can exceed 50% with pregnancy.3 The panel discussed pregnancy termination as a potentially live saving procedure, both for those with known cardiovascular disease and for those whose disease manifests itself during pregnancy. While the legality of abortion and the ability to counsel our patients fluctuates, the safety and health of our cardiovascular patients and their right to safe and comprehensive reproductive care should remain in the forefront of our mind.
Dr. Skowronski is chief cardiology fellow at UPMC and served as a CardioNerds Conference Scholar for the American College of Cardiology 2023 Scientific Sessions.
Citations:
- Jackson Women’s Health Orgn, et al v. Thomas Dobbs, et al, (5th2020). https://www.govinfo.gov/app/details/USCOURTS-ca5-19-60455.
- Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mortality in the United States, 2011-2013. Obstet Gynecol. 2017;130(2):366-373. doi:10.1097/AOG.0000000000002114
- Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-3241. doi:10.1093/eurheartj/ehy340
