Cardiovascular disease (CVD) has emerged as a growing threat to maternal health in the United States, with death rates more than doubling over the past two decades, according to research presented at the American College of Cardiology's annual meeting in Chicago.
The study, led by researchers from Rutgers New Jersey Medical School, found that CVD-related maternal mortality increased from 3.62 deaths per million women of reproductive age in 1999 to 9.08 deaths per million in 2022. This translates to approximately 600 deaths in 2022 alone.
"We're heading in the wrong direction," said lead researcher Dr. Mohammad Ahabab Hossain, a resident physician at Rutgers. "The United States is supposed to be a global leader in advancing health and medicine, and the fact that we still have pregnant women who are dying—often because of preventable causes—should sound alarm bells."
Stark Racial and Regional Disparities
The analysis revealed significant disparities across both race and geography. Black women experienced a mortality rate of 21.91 per million between 2018 and 2022—more than three times higher than the rate for white women (7.10 per million).
Regional differences were equally concerning. Southern states recorded the highest maternal CVD mortality rate at 12.14 deaths per million, compared to just 5.41 deaths per million in Western states.
These disparities likely reflect broader social and economic inequalities, including limited access to specialized healthcare services and higher prevalence of cardiovascular risk factors in certain populations.
Pandemic Impact and Contributing Factors
The researchers identified a notable spike in maternal deaths during the COVID-19 pandemic, with rates peaking at 10.52 deaths per million in 2021. This increase may be attributed to disruptions in prenatal care access and hesitancy to visit medical facilities during lockdowns.
The study examined data from the CDC WONDER database, identifying 7,581 maternal deaths from cardiovascular causes between 1999 and 2022. These deaths resulted from conditions including peripartum cardiomyopathy, hypertensive disorders of pregnancy, and thromboembolic events.
"Part of the reason this is happening is because heart disease and hypertension are becoming more and more prevalent, as are the conditions that are connected to heart disease, like diabetes and obesity. As a result, we wind up with more high-risk pregnancies," Hossain explained.
Prevention Opportunities
Experts emphasize that many of these deaths are preventable with appropriate intervention. Women with pre-existing cardiovascular conditions or risk factors require specialized care throughout pregnancy and the postpartum period.
"If a patient has a history of hypertension or other preexisting cardiovascular disease, that patient should be connected with a high-risk obstetrics clinic to receive the care they need," said Hossain.
The findings highlight the need for improved screening protocols, better preconception counseling, and more accessible specialized care for vulnerable populations. Early identification of risk factors and appropriate management could significantly reduce the incidence of severe complications and death.
A Call to Action
The study adds to mounting evidence of a maternal health crisis in the United States, where overall maternal mortality rates already exceed those of other developed nations. Cardiovascular disease remains the leading cause of death during pregnancy and the postpartum period.
Researchers are calling for targeted interventions to address these disparities, including expanded access to specialized care for vulnerable populations, enhanced cardiovascular screening during prenatal visits, and better coordination between cardiologists and obstetricians.
As Dr. Hossain noted, "The fact that there are disparities based on race means we need to pay better attention to more vulnerable populations, specifically Black women."
The findings underscore the urgent need for a comprehensive approach to maternal cardiovascular health that addresses both medical risk factors and the social determinants that contribute to these persistent disparities.
