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Status of Maternal Cardiovascular Health in American Indian and Alaska Native Individuals: A Scientific Statement
Insights
Cardiovascular disease is a major cause of maternal death for American Indian and Alaska Native individuals. Improving their cardiovascular health requires addressing systemic racism, historical trauma, and social determinants of health.
Area of Science:
- Public Health
- Cardiology
- Health Equity
Background:
- Cardiovascular disease (CVD) is the primary cause of pregnancy-related mortality in the U.S.
- American Indian and Alaska Native (AI/AN) individuals face disproportionately high rates of maternal death and morbidity.
- Limited data exist on CVD-related maternal deaths within the AI/AN population, highlighting critical knowledge gaps.
Purpose of the Study:
- To provide an overview of cardiovascular health status in AI/AN birthing individuals.
- To identify causes of maternal death and morbidity related to cardiovascular disease.
- To propose a multidisciplinary framework for improving cardiovascular and cerebrovascular health across the preconception, pregnancy, and postpartum continuum for AI/AN individuals.
Main Methods:
- Review of current literature and data on cardiovascular health in AI/AN birthing individuals.
- Analysis of factors contributing to maternal cardiovascular mortality and morbidity.
- Development of a stepwise, multidisciplinary framework incorporating American Heart Association's Life's Essential 8.
Main Results:
- Highlights the impact of substance use, mental health conditions, and lifestyle factors on CVD risk.
- Addresses the influence of institutional racism, historical trauma, and colonization on social determinants of health and outcomes.
- Emphasizes the underreporting of disaggregated data for AI/AN populations in maternal health outcomes.
Conclusions:
- Optimizing cardiovascular health for AI/AN birthing individuals necessitates culturally appropriate care and trust-building.
- Engaging stakeholders, addressing social determinants of health, and expanding the AI/AN healthcare workforce are crucial.
- Systemic issues including racism and historical trauma must be confronted to improve maternal cardiovascular health outcomes.
Abstract:
Cardiovascular disease is the leading cause of pregnancy-related death in the United States. American Indian and Alaska Native individuals have some of the highest maternal death and morbidity rates. Data on the causes of cardiovascular disease-related death in American Indian and Alaska Native individuals are limited, and there are several challenges and opportunities to improve maternal cardiovascular health in this population. This scientific statement provides an overview of the current status of cardiovascular health among American Indian and Alaska Native birthing individuals and causes of maternal death and morbidity and describes a stepwise multidisciplinary framework for addressing cardiovascular disease and cerebrovascular disease during the preconception, pregnancy, and postpartum time frame. This scientific statement highlights the American Heart Association's factors for cardiovascular health assessment known collectively as Life's Essential 8 as they pertain to American Indian and Alaska Native birthing individuals. It summarizes the impact of substance use, adverse mental health conditions, and lifestyle and cardiovascular disease risk factors, as well as the cascading effects of institutional and structural racism and the historical trauma faced by American Indian and Alaska Native individuals. It recognizes the possible impact of systematic acts of colonization and dominance on their social determinants of health, ultimately translating into worse health care outcomes. It focuses on the underreporting of American Indian and Alaska Native disaggregated data in pregnancy and postpartum outcomes and the importance of engaging key stakeholders, designing culturally appropriate care, building trust among communities and health care professionals, and expanding the American Indian and Alaska Native workforce in biomedical research and health care settings to optimize the cardiovascular health of American Indian and Alaska Native birthing individuals.
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