Chambers Melissa E, De Zoysa Madushka Y, Hameed Afshan B
Department of Obstetrics and Gynecology, University of California Irvine, Orange, CA 92868, USA.
Department of Maternal Fetal Medicine, University of California Irvine, Orange, CA 92868, USA.
J Cardiovasc Dev Dis. 2022 Mar 17;9(3):89. doi: 10.3390/jcdd9030089.
Maternal mortality in the United States has been on the rise. Every year, about 700 women die from pregnancy-related complications. Cardiovascular disease (CVD) accounts for a large majority of pregnancy-related deaths driven by the lack of recognition and delays in diagnosis due to the overlap of normal pregnancy symptoms with those of CVD. Risk factors for CVD including race, advanced maternal age, hypertension, diabetes, obesity, socioeconomic status, and geographic region play an important role in CVD-related deaths. Several risk assessment models are available to stratify women with a known diagnosis of CVD. However, most women who die from CVD during pregnancy or the postpartum period do not have a prior diagnosis of CVD, and cardiomyopathy is an important contributor. The California Maternal Quality Care Collaborative (CMQCC) developed an algorithm to screen all pregnant and postpartum women to allow stratification into low or high risk for CVD. The algorithm has been validated in diverse patient populations. We propose universal CVD screening for all women in the antepartum and postpartum period to identify women at risk and to provide education and awareness for both patients and healthcare providers. This screening tool would work to reduce the increasing rates of severe maternal mortality and morbidity while having a significant impact on healthcare costs in the United States.
美国孕产妇死亡率一直在上升。每年，约700名女性死于与妊娠相关的并发症。心血管疾病（CVD）占与妊娠相关死亡的大部分，这是由于正常妊娠症状与CVD症状重叠导致识别不足和诊断延误所致。CVD的风险因素包括种族、高龄孕产妇、高血压、糖尿病、肥胖、社会经济地位和地理区域，在与CVD相关的死亡中起重要作用。有几种风险评估模型可用于对已知患有CVD的女性进行分层。然而，大多数在孕期或产后死于CVD的女性之前并未被诊断出患有CVD，而心肌病是一个重要因素。加利福尼亚孕产妇质量护理协作组织（CMQCC）开发了一种算法，用于筛查所有孕妇和产后女性，以便将其分为CVD低风险或高风险人群。该算法已在不同患者群体中得到验证。我们建议对所有产前和产后女性进行普遍的CVD筛查，以识别有风险的女性，并为患者和医疗服务提供者提供教育和提高认识。这种筛查工具将有助于降低严重孕产妇死亡率和发病率的上升趋势，同时对美国的医疗成本产生重大影响。
