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MedStar Health Research Institute is planning research initiatives that could make childbirth and recovery safer in D.C. and beyond.
Pregnancy puts a significant stress on the cardiovascular system. During pregnancy, the body produces 40-50% more blood, and the blood vessels must expand to accommodate.
In a healthy person, that extra blood doesn’t cause a problem. But with pre-existing conditions like high blood pressure or risk factors like diabetes, smoking, or obesity, it can be a lot for the body to handle.
For Black women who face additional stressors such as bias, pregnancy can be a “perfect storm” for health complications. Black people have four to five times higher rates of complications like cardiovascular disease, high blood pressure, and preeclampsia. They are almost three times as likely as white people to die during pregnancy.
Research has shown that more than 80% of pregnancy-related deaths could be prevented. As a leading center for heart and obstetric studies, MedStar Health Research Institute combines these specialties into a cardio-obstetrics research program to unite heart, vascular, and pregnancy data and help more mothers live longer healthier lives.
How can health systems can make a difference?
The conditions that lead to disparities in maternal cardiovascular outcomes are complicated and challenging. Our program will focus on three critical areas of research.
Social determinants of health.
Factors such as education, transportation, healthy food, and a safe environment can contribute to 80% of health outcomes. Health systems must work with community members and organizations to become better integrated in neighborhoods and help close health gaps.
This includes home visitation and collaborative programs like D.C. Safe Babies Safe Moms, a MedStar Health initiative to work with community organizations to support patients and improve health outcomes. Health systems are crucial in building connections to other support services like WIC and the National Diabetes Prevention Program, a public-private partnership to prevent or delay type 2 diabetes with evidence-based lifestyle change programs.
For example, in Montgomery County, the Start More Infants Living Equally Healthy (SMILE) program offers various support services to Black women in the county, regardless of income or insurance status.
Related reading: New Study: Stress of Daily Racism Linked to Hypertension Among Black Young Adults.
Improving access to healthcare.
Prenatal and postnatal care is vital to pregnancy-related health. Up to 40% of women face barriers to attending their postpartum doctor’s visit, yet more than half of all pregnancy-related deaths occur in the first year after delivery.
With researcher and midwife Loral Patchen, PhD, and maternal-fetal medicine physician Dr. Victoria Greenberg, we’re working to launch a program to study one-on-one maternal health coaching in healthy lifestyle habits.
We’re also studying ways to use telehealth and app-based programs like Baby Scripts and Mahmee to monitor new mothers’ cardiovascular health from home. Along with patient education opportunities, these technologies can help detect issues like high blood pressure sooner during the critical postpartum period.
Community transitional care clinics could be another step in reducing barriers. These “one-stop shops” could include obstetricians, pediatricians, cardiologists, and health coaches under one roof, meeting the family’s health needs in one visit.
Related reading: Cardio-Obstetrics: Supporting Heart Health Through Pregnancy and Beyond.
Working against implicit bias.
Studies have shown the connection between implicit bias—the thoughts and feelings about other people that unknowingly affect our actions—and poorer health outcomes. Bias impacts patient-provider communication, for example, when Black patients’ symptoms or experiences are dismissed.
As just one example, studies have shown that college-educated Black women are almost twice as likely to die during pregnancy than high-school-educated white women, regardless of their access to care.
To correct this, healthcare providers of all backgrounds must approach the issue of implicit bias with humility. Implicit bias can be challenging to recognize, let alone change. Health systems administrators can help by providing anti-bias training and encouraging staff to confront implicit bias without shame.
Related reading: First-of-its-Kind Research Finds Racial Disparities in Cardiac Clinical Trials Start Before Enrollment.
Discovering the future of cardio-obstetrics.
As we build the cardio-obstetrics program, collaboration is ongoing between cardiologists, obstetricians, midwives, and doulas to streamline our processes. Our teams communicate constantly to ensure birthing individuals get timely cardiology care. Cross-discipline clinical and research collaboration can help reduce pregnancy-related disparities.
At the same time, we’re educating patients about the importance of pre-pregnancy and postpartum health. In preconception counseling, we discuss the importance of healthy habits like exercise, nutrition, quality sleep, quitting smoking, and knowing your heart health numbers and family history.
