Three distinguished health care professionals joined President Haywood L. Brown, MD, FACOG, during Friday’s President’s Panel, “The New Postpartum Visit: Beginning of Lifelong Health.”
Following presentation of lectures, Dr. Brown conducted a “fireside chat” with American College of Cardiology President Mary N. “Minnow” Walsh, MD; Ambassador Nancy G. Brinker, founder of the Susan G. Komen for the Cure Breast Cancer Organization; and Wanda D. Barfield, MD, MPH, assistant surgeon general of the U.S. Public Health Service and director of the Division of Reproductive Health within the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control.
“When it comes to patients or even policy makers, there’s no more powerful voice than that of a physician, and so I encourage each of you to continue being vocal on all of these issues. We can no longer afford to see the patient advocacy just be on the part of patients. We need physician advocacy,” said Ambassador Brinker, who delivered The Hale Lecture.
Sharing her experience in founding Susan B. Komen for the Cure, she highlighted the continuing need for breast cancer and cervical cancer screening worldwide and the important need for physicians to take their messages to the community level.
“There are many reasons for disparities, but the most important is access to care. Of the 40,000 American lives lost to breast cancer each year, it’s believed that one third to one half could be saved if patients had access to high quality care in a timely fashion,” she said.
During The Anna Marie D’Amico Lecture, Dr. Barfield discussed mental health and opioid abuse and their effects on pregnancy and postpartum care.
She noted that depression has a significant impact on reproductive health and chronic disease through a lower use of effective contraceptive methods, preconception health issues of diabetes, obesity, and physical inactivity, and substance use and other mental health conditions. There’s a greater use of alcohol, tobacco, and illicit drugs, and women with depression are less likely to quit smoking during pregnancy.
“We need to better understand the gaps in the delivery of care, the transition to home, and potential hazards that occur with regard to substance abuse and mental health in order to save women’s lives,” Dr. Barfield said.
She said one pathway to better data is by harnessing the power of maternal mortality review committees. About half the states have them.
“We need to bridge gaps in terms of understanding underlying causes of maternal mortality. Over 60 percent of pregnancy related deaths are found to be preventable, and we know that mental health and substance abuse disorders contribute to these deaths,” she said.
Dr. Walsh called for a new interdisciplinary team approach to high-risk patients that she named “cardio-obstetrics.”
“We need to have cardiologists familiar with these disease processes as well as those experts in ob-gyn, maternal-fetal medicine and anesthesiology, so the whole team can meet to discuss care of these high-risk patients,” she said during The Jim and Midge Breeden Lecture, noting that ACOG and the American College of Cardiology have worked together on a number of projects toward that goal.
Although the normal changes in pregnancy such as increased plasma volume levels and decreased hematocrit and hemoglobin are natural, they are still stressors to a woman’s cardiovascular system.
“To some extent we really need to think of pregnancy as our first stress test,” she said. “We’ve done little in our cardiovascular community to recognize the fact that this stress test is an important one and that we should include how a woman does on her first stress test in her history.”
She added that in many cardiovascular electronic medical records, obstetric history isn’t included in the patient’s record. It’s important to consider the impact of pregnancy, particularly in regard to hypertension, on the patient’s future cardiovascular disease risk, she said.
“Preeclamptic women have up to a four-fold increased risk for developing chronic hypertension, and ischemic heart disease is doubled at 15-year follow-up,” she said. “This is crucial for us to recognize that that initial stress test—that pregnancy—when we unmask hypertension, preeclampsia, and, of course, eclampsia. We have to pay attention to that later on as we’re caring for women.”