To ensure a safe, predictable pregnancy for patients with heart disease, a team of Duke Health specialists from anesthesiology, cardiology, and maternal-fetal medicine collaborate to provide comprehensive, personalized care through conception, delivery, and post-partum follow-up.

The Duke Pregnancy Heart Center offers convenient care from experienced physicians that allows patients to meet with several clinicians during a single visit, helping ensure that comprehensive care is planned and coordinated safely.

Experienced maternal nurse navigators establish relationships with patients and families to help simplify appointments, schedule follow-up care, and provide an accessible contact point for questions or concerns.

Jerome J. Federspiel, MD, PhD, a Duke maternal-fetal medicine specialist, leads a monthly planning conference created to coordinate planning for complex cases as well as proactive management for each stage of a pregnancy and delivery.

“Pregnancies involving patients with heart disease often have additional risks compared to those without heart disease,” says Federspiel. “We know that careful planning during pregnancy is essential. For this reason, our team discusses every patient during a monthly review throughout the pregnancy to monitor progress and, of course, more frequently when necessary.

“We want to make the delivery and postpartum period, which is the highest risk time for complications of some kinds of heart disease, as safe and happy as possible.”

During the past three years, a clinic created to treat cardiovascular conditions in women who are pregnant has become a fast-growing partner of Duke Maternal-Fetal Medicine Division (MFM) and the Pregnancy Heart Center.

Cary C. Ward, MD, an adult congenital heart disease specialist who occasionally treated pregnant patients as a part of her practice, now works closely with the Federspiel’s group. Her patients often presented with complex, challenging conditions, Ward says, which triggered her interest in addressing cardiovascular risk factors in a more effective manner. The combined program was launched in September 2022 with the addition of Mary-Louise Meng, MD, who helped form a third pillar of care with her anesthesiology partners. Ward and Meng join Federspiel in the monthly care planning sessions.

“Some patients in my congenital practice have mechanical heart valves and wanted to become pregnant,” says Ward. “These individuals required very specialized care and led to our interest in developing a program for women with cardiovascular disease and pregnancy.”

One contributor to the fast growth of the center is the fact that the multidisciplinary approach helped patients with immediate health risks, Ward says. The number of active patients cared for by the interdisciplinary team has tripled since 2022.

But the demand for comprehensive cardiac care before and during pregnancy remains high, Ward says. She has personally witnessed the medical challenges facing pregnant women in the United States. “Among nations of the same socioeconomic profile, the statistical risks associated with pregnancy are significantly higher in the U.S. than in other countries,” Ward says.

These risks have continued to rise in recent years. Since the creation of the CDC’s Pregnancy Mortality Surveillance System, the number of reported pregnancy-related deaths in the United States increased from 7.2 deaths per 100,000 live births in 1987 to 32.9  deaths per 100,000 live births in 2021. Among African American women who are pregnant, the maternal mortality rate is twice as high, a statistic that highlights the health care disparities in this field.

The reasons for the increase in overall maternal mortality are multifactorial, but the experience at Duke has convinced Ward and her colleagues that pregnant women need proactive care as soon as possible.

“Women are becoming pregnant later in life, and have higher rates of diabetes, obesity, and elevated blood pressure,” Ward adds. “These risk factors can contribute to hypertensive disorders of pregnancy such as preeclampsia, all of which are associated with a higher risk of maternal death.”

The pregnancy heart team is also active in research to improve the care of patients with cardiac disease. Duke physicians and nursing colleagues are part of the leadership team for a statewide quality initiative to improve the care of patients with pregnancy-related heart disease across North Carolina.