Abstract

HEART DISEASES IN PREGNANCY: PIONEERING EFFORTS IN RAISING AWARENESS

Sumit Fogla*

ABSTRACT

Heart disease is the leading cause of pregnancy-associated maternal deaths. Cardinal causes of this death include heart attack (myocardial infarction), peripartum cardiomyopathy, and cardiac electrical disturbances (arrhythmias) and pulmonary embolism. Increasingly older age of pregnant women, better medical care of non-cardiac complications of pregnancy and increasing awareness about heart disease in pregnancy have now thrust heart disease into the limelight as the most important cause of death in the pregnant woman. Medical care tends to centrally focus towards the newborn child, resulting in rather missed opportunities for education, surveillance, and possible intervention for women at risk. A far-change in these attitudes is being promoted by the pioneering work and campaign being led by Dr. Mohan Mallikarjuna Rao Edupuganti, Assistant Professor of Cardiology at the VA (Veterans Affairs) Oklahoma Medical Center. Dr. Edupuganti has led a vigorous web-based and scholarly campaign to promote cognizance of these issues by attending clinicians, including cardiologists, obstetricians and primary care physicians. In addition, he has kick-started educational opportunities and didactics to escalate medical community awareness. Dr. Edupuganti pointed out the escalating statistics and that in the United States, between the years 2000 and 2014, the maternal death rate increased by 6.6%. The rate of death during or within one year of pregnancy resulting from cardiovascular causes was 3.48 per 100,000 live births between the years 1998-2005. In 2006–2010, it elevated to 4.23. A new algorithm has been devised by Dr. Edupuganti tailored to the pregnant woman with chest pain. This has the potential to take precedence over earlier methodologies for risk stratification in pregnant patients with ischemic heart disease and heart attacks in pregnancy, and can be critical base material for testing in prospective clinical trials. Earlier Dr. Edupuganti has pointed out disparities in conductance of clinical trials, especially in relation to non-inclusion of woman. Dr. Edupuganti raised particular concern regarding ethnic and racial disparities in maternal outcomes, especially in relation to African-American women. The risk of pregnancy-related death in this cohort is thrice in comparison to other women. This may partially be due to higher rates of preexisting cardiovascular disease. Disparities in care may also result from negligence and provider bias for a cohort of the population. We touched base with Dr. Edupuganti to obtain glimpse into his insights regarding identification and management of this very important, but apparently ignored, clinical condition of heart diseases that disruptively threaten maternal and child health pregnancy.

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