Cardio-obstetrics de novo: a state-level, evidence-based approach for addressing maternal mortality and severe maternal morbidity in Georgia

M aternal mortality is a critical indicator of a nation ' s overall health. Factors that contribute to maternal mortality are challenging to assess and complicated to resolve. As a measure of health quality, maternal mortality can indicate broad systemic and social challenges. 1 Variation exists across health systems, states, and countries with respect to identifying, evaluating, and reporting maternal deaths. In 1986, the Centers for Disease Control and Prevention implemented the Pregnancy Mortality Surveillance System (PMSS) to improve understanding of the causes and risk factors for Pregnancy-Related Deaths (PRDs). 2 - 4 PMSS data include women who died during pregnancy or up to 1 year after Georgia has a higher rate of severe maternal morbidity and mortality when compared with the rest of the United States. Evidence gained from the Georgia Maternal Mortality Review Committee identi fied areas of focus for high-yield clinical initiatives for improvement in maternal health outcomes. Cardiovascular disease, including cardiomyopathy, coronary conditions, and preeclampsia with or without eclampsia, is the most common cause of pregnancy-related death in non-Hispanic Black women in Georgia. The development of a cardio-obstetrics program is an initiative to advance health equity by decreasing cardiovascular morbidity and mortality. This report describes the following: (1) state-level advocacy for improving maternal health outcomes with funding gained through the legislative process and partnership with a governmental agency; (2) cardio-obstetrics program development based on evidence gained from the maternal mortality review process; and (3) implementation of a cardio-obstetrics service, beginning with a focused approach for capacity building and understanding barriers to care.