According to a new scientific statement announced by American Heart Association, more than 60 percent of American Indian and Alaska Native (AI/AN) women already have suboptimal heart health when they become pregnant.
“Cardiovascular disease rates are particularly high in AI/AN women of reproductive age,” said Garima Sharma, M.D., FAHA. Dr. Sharma chaired the writing committee for the scientific statement. Sharma also says early detection and management are crucial for addressing cardiovascular disease (CVD).
“We hope to bring to the forefront the disproportionate burden of CVD, adverse pregnancy outcomes and poor maternal health in American Indian and Alaska Native women as maternal mortality in the United States continues to increase,” according to Sharma.
This is the first time an American Heart Association scientific statement addressed maternal AI/AN heart health.
Pregnancy Risks Related to Heart Health
The scientific statement highlights pregnancy risks related to cardiovascular health in AI/AN women including:
- Of those giving birth between ages 35 to 40, AI/AN women are five times as likely to die compared to white women.
- Peripartum cardiomyopathy, a form of heart failure during and immediately after pregnancy, is responsible for more deaths (14.5%) among AI/AN women than women of any other race or ethnicity.
- AI/AN women also experience significantly higher rates of other pregnancy complications in comparison to white women, such as infection, postpartum hemorrhage or gestational diabetes.
- When present, high blood pressure is a strong predictor of CVD. Pregnant people with obesity, which is prevalent among AI/AN women, are at greater risk for preeclampsia. This is a serious blood pressure condition that develops during pregnancy.
- Only 60.4% of AI/AN women sought prenatal care in the first trimester compared with 81.6% of non-Hispanic white women.
Recommendations for Addressing Heart Health
The statement makes several recommendations to address cardiovascular risks among AI/AN women, including:
- Addressing adverse childhood experiences, bolstering existing family connections and improving family functioning through referrals to child and adult mental health services, parenting programs and social services to counter the effects of past trauma and reduce additional family stressors.
- Establishing a framework free of stigma and judgment to address AI/AN women’s mental health and substance use.
- Recognizing the personal stories of AI/AN women living with heart disease as a resource for health care professionals and researchers. These women may also help reach others in the community as ambassadors.
- Providing appropriate heart health screenings and transfering high-risk pregnancies to multi-disciplinary, team-based care. These teams could include preventive cardiology, maternal-fetal medicine, cardio-obstetrics and psychiatry.
- Developing an accessible workforce that provides culturally sensitive care, incorporating prenatal care, mental health care, and birth workers. These could also include those from the tribal community.
“Health systems and community-based organizations that identify trauma and teach and celebrate resilience are essential to address mental and behavioral health needs and to promote healing of AI/AN women, families and communities,” the statement says.
SMALL NUMBER OF NATIVE WOMEN IN STUDIES
Despite these needs, the small numbers of AI/AN women in clinical trials limits the evidence available for study. The lack of health registries with data separated for the AN/AI population also limits available evidence.
“We need to understand the health status of AI/AN populations and work collaboratively to improve cultural competency among our clinicians and partner with policymakers, health care professionals, local communities and tribal leadership to design better studies and include the voices of these patients in providing appropriate care,” said Sharma.
Co-authors of the statement are Vice Chair Allison Kelliher, M.D.; Jason Deen, M.D.; Tassy Parker, Ph.D., R.N.; Tracy Hagerty, M.D.; Eunjung Esther Choi, M.D.; Ersilia M. DeFilippis, M.D.; Kimberly Harn, M.Ed., R.T. (R), (M.R.); Robert Dempsey, M.D., FAHA; and Donald M. Lloyd-Jones, M.D., Sc.M., FAHA. Authors’ disclosures are listed in the manuscript.
LEARN MORE
You can learn more by visiting the scientific manuscript online.
