Wednesday, September 27, 2023
9/27/2023
Over the past three decades, there have been alarming upward trends in the rates of maternal morbidity and mortality in the United States. Overall, the identified clinical causes of maternal death are: cardiovascular conditions (14%), hemorrhage (13%), infection (11%) embolism (10%), cardiomyopathy (95), mental health conditions (9%) and preeclampsia/eclampsia (8%) but these conditions vary by race/ethnicity. For Black, non-Hispanic women, the two leading causes of death were cardiomyopathy and cardiovascular conditions, and mental conditions was the leading cause among White, non-Hispanic women.1 Obesity, hypertension, smoking, opioid use and sleep disorders are also conditions and behaviors that have been found to be associated with maternal morbidity such as hemorrhage, preeclampsia and cardiomyopathy. These could potentially be addressed in primary care before and between pregnancies.2-6 The National Heart, Lung Blood Institute (NHLBI) is participating in a trans-National Institutes of Health (NIH) effort to improve women’s health, particularly maternal morbidity and mortality. A plan – Advancing Science for the Health of Women, The Trans-NIH Strategic Plan for Women’s Health Research – was developed for the period 2019 – 2023. This plan provides a framework that recognizes the complex interactions of multiple factors that affect women’s health across the life course, including pregnancy. Life course theory posits that health development begins before conception and continues across the life span. It suggests that a complex play of biologic, behavioral, psychological, and social protective and risk factors contribute to health outcomes, and that health status reflects the cumulative lifetime exposure to these factors. The guiding principles for this plan are consideration of the complex factors affecting women’s health, the inclusion of diverse populations that are disproportionately affected by morbidity and mortality, and active engagement of a diverse group of scientists.7 The NIH approach to reducing maternal morbidity and mortality will aim to enhance health disparities research, increase the understanding of social determinants and other risk factors (including environmental risk factors), improve care (antepartum, intrapartum and postpartum) and management, provide insight to psychological exposures such as stress, discrimination and caregiving, understand coping behaviors in families affected by maternal morbidity or mortality, and investigate the role of implicit bias in the health care systems regarding pregnancy.8 Within NHLBI, maternal and women’s health priorities span all of the objectives of the NHLBI strategic vision, and NHLBI has supported a number of maternal health programs looking at hypertension, sleep disorders, and other pregnancy complications including pre-eclampsia, eclampsia, and gestational diabetes. The goal of the NHLBI 3M Administrative Coordinating Center (3M ACC) is to engage communities and networks in areas that experience high levels of maternal morbidity and mortality. The 3M ACC will support the preliminary work necessary to identify and prepare a group of community-based organizations to respond to future funding opportunities. The 3M ACC will develop the infrastructure to support this group of Maternal Morbidity and Mortality Regional Coalitions (3M RCs) and provide scientific support and coordination to NHLBI on emerging scientific needs. Specifically, the 3M ACC will support these programmatic objectives: •¿ Identify research groups and organizations with existing and relevant expertise and community partnerships. •¿ Conduct landscape analyses and community-informed needs assessments. •¿ Identify within each community implementation opportunities and barriers to improve delivery of evidence-based care to reduce maternal morbidity and mortality. •¿ Develop and conduct early-stage tests of implementation approaches to identify potential strategies to ensure the proposed approaches are acceptable, feasible, scalable, and sustainable and to identify barriers.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
