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Maternal Cardiac Health: Improving Outcomes and Lifelong Cardiovascular Care (RECORDING)


Maternal Cardiac Health: Improving Outcomes and Lifelong Cardiovascular Care (RECORDING) Banner

  • Overview
  • Faculty
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Date & Location
Thursday, January 30, 2025, 12:00 AM - Saturday, January 29, 2028, 11:59 AM, On Demand

Overview

Internet Enduring Material sponsored by Stanford University School of Medicine.

Maternal cardiac disease remains one of the leading causes of maternal mortality in the United States, and its prevalence continues to rise as advancements in healthcare enable more women with congenital heart disease to reach reproductive age. This recorded lecture provides an in-depth exploration of the challenges and opportunities associated with diagnosing and managing maternal cardiac disease, emphasizing the critical role of early detection and intervention. The discussion highlights the window of opportunity during a woman’s reproductive years to mitigate long-term cardiovascular risks and improve overall health outcomes. Participants will gain insights into the latest research on obstetrical and neonatal outcomes linked to both acquired and congenital cardiac conditions.


Registration

  Release Date: January 30, 2025
  Expiration Date: January 29, 2028
  Estimated Time to Complete: 1 hour, 10 minutes
  Registration Fee: FREE
*Originally recorded on 01/23/2025
Click the Begin tab to launch this course. 


Credits
AMA PRA Category 1 Credits™ (1.25 hours), AAPA Category 1 CME credits (1.25 hours), ANCC Contact Hours (1.25 hours), Non-Physician Participation Credit (1.25 hours)

Target Audience
Specialties - Maternal-Fetal Medicine, Neonatology, Obstetrics & Gynecology, Pediatrics
Professions - Advance Practice Nurse (APN), Fellow/Resident, Non-Physician, Nurse, Physician, Physician Associate, Registered Nurse (RN), Student

Objectives
At the conclusion of this activity, learners should be able to:

  1. Analyze the impact of maternal cardiac disease on maternal and neonatal outcomes, including risks such as preterm birth, intrauterine growth restriction, and prolonged maternal hospitalization.
  2. Examine the relationship between congenital and acquired heart disease and adverse perinatal outcomes, including neonatal complications and high-acuity maternal care requirements.
  3. Identify strategies for early detection and risk reduction of cardiovascular disease during the reproductive years, addressing long-term health outcomes for women with congenital or acquired cardiac conditions.
  4. Evaluate current trends and challenges in managing maternal cardiac disease and their implications for clinical practice.
  5. Apply evidence-based practices for optimizing maternal and neonatal outcomes in pregnancies complicated by cardiac conditions.

Accreditation

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 1.25 AMA PRA Category 1 CreditsTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC) 
Stanford Medicine designates this enduring material for a maximum of 1.25 ANCC contact hours.

American Academy of PAs (AAPA)
Stanford Medicine has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This enduring material is designated for 1.25 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation. 


Additional Information

Accessibility Statement
 Stanford University School of Medicine is committed to ensuring that its programs, services, goods and facilities are accessible to individuals with disabilities as specified under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Amendments Act of 2008.  If you have needs that require visual, auditory, cognitive, or mobility accommodations, please contact the CME office.

Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

References/Bibliography

American College of Obstetricians and Gynecologists' Presidential Task Force on Pregnancy and Heart Disease and Committee on Practice Bulletins—Obstetrics (2019). ACOG Practice Bulletin No. 212: Pregnancy and Heart Disease. Obstetrics and gynecology, 133(5), e320–e356. https://doi.org/10.1097/AOG.0000000000003243

Auger, N., Potter, B. J., Bilodeau-Bertrand, M., & Paradis, G. (2018). Long-Term Risk of Cardiovascular Disease in Women Who Have Had Infants With Heart Defects. Circulation, 137(22), 2321–2331. https://doi.org/10.1161/CIRCULATIONAHA.117.030277

Beshar, I. E., Panelli, D., Lee, C. J., Dominguez, L. V., Padron, E., Ramirez, N. J., Ansari, J., Khandelwal, A., & Bianco, K. (2023). Preterm Birth Doubles in a Cardiac Affected Population: The Added Factor of Maternal Depression. Reproductive Sciences, Springer, 30.

Blatt, A., Svirski, R., Morawsky, G., Uriel, N., Neeman, O., Sherman, D., Vered, Z., & Krakover, R. (2010). Short and long-term outcome of pregnant women with preexisting dilated cardiomypathy: an NTproBNP and echocardiography-guided study. The Israel Medical Association journal : IMAJ, 12(10), 613–616.

Bright, R. A., Lima, F. V., Avila, C., Butler, J., & Stergiopoulos, K. (2021). Maternal Heart Failure. Journal of the American Heart Association, 10(14), e021019. https://doi.org/10.1161/JAHA.121.021019

Brouilette, S., Singh, R. K., Thompson, J. R., Goodall, A. H., & Samani, N. J. (2003). White cell telomere length and risk of premature myocardial infarction. Arteriosclerosis, thrombosis, and vascular biology, 23(5), 842–846. https://doi.org/10.1161/01.ATV.0000067426.96344.32

Calado, R. T., & Young, N. S. (2009). Telomere diseases. The New England journal of medicine, 361(24), 2353–2365. https://doi.org/10.1056/NEJMra0903373

California Maternal Quality Care Collaborative. (2017). Improving Health Care Response to Cardiovascular Disease in Pregnancy and Postpartum. Cardiovascular Disease in Pregnancy Task Force, CMQCC. https://www.cmqcc.org/resource/improving-health-care-response-cardiovascular-disease-pregnancy-and-postpartum

California Pregnancy-Associated Mortality Review Committee. (2018). The California Pregnancy-Associated Mortality Review: Report from 2002 to 2007 Maternal Death Reviews. California Department of Public Health (CDPH), Maternal, Child and Adolescent Health (MCAH) Division. https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/PAMR/CA-PAMR-Report-1.pdf

Centers for Disease Control and Prevention. (1999). Achievements in Public Health, 1900-1999: Healthier Mothers and Babies. Centers for Disease Control and Prevention, MMWR Weekly, 48(38);849-858. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm

Cho, L., Kaunitz, A. M., Faubion, S. S., Hayes, S. N., Lau, E. S., Pristera, N., Scott, N., Shifren, J. L., Shufelt, C. L., Stuenkel, C. A., Lindley, K. J., & ACC CVD in Women Committee (2023). Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long?. Circulation, 147(7), 597–610. https://doi.org/10.1161/CIRCULATIONAHA.122.061559

Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., Casey, B. M., & Sheffield, J. S. (Eds). (2018). Williams Obstetrics, 25e. McGraw-Hill Education. https://obgyn.mhmedical.com/content.aspx?bookid=1918&sectionid=138822591

Darmawan, K. F., Panelli, D. M., Mayo, J. A., Leonard, S. A., Girsen, A., Carmichael, S. L., & Bianco, K. (2023). Severe maternal morbidity among people with cardiac disease: getting to the heart of the problem. American Journal of Obstetrics & Gynecology, 228(1), S163-S164. https://doi.org/10.1016/j.ajog.2022.11.314

Easter, S. R., Valente, A. M., & Economy, K. E. (2020). Creating a Multidisciplinary Pregnancy Heart Team. Current treatment options in cardiovascular medicine, 22(1), 3. https://doi.org/10.1007/s11936-020-0800-x

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8

Hilmert, C. J., Dominguez, T. P., Schetter, C. D., Srinivas, S. K., Glynn, L. M., Hobel, C. J., & Sandman, C. A. (2014). Lifetime racism and blood pressure changes during pregnancy: implications for fetal growth. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 33(1), 43–51. https://doi.org/10.1037/a0031160

Kampman, M. A., Balci, A., Groen, H., van Dijk, A. P., Roos-Hesselink, J. W., van Melle, J. P., Sollie-Szarynska, K. M., Wajon, E. M., Mulder, B. J., van Veldhuisen, D. J., Pieper, P. G., & ZAHARA II investigators (2015). Cardiac function and cardiac events 1-year postpartum in women with congenital heart disease. American heart journal, 169(2), 298–304. https://doi.org/10.1016/j.ahj.2014.11.010

Kansal, M., Hibbard, J. U., & Briller, J. (2012). Diastolic function in pregnant patients with cardiac symptoms. Hypertension in pregnancy, 31(3), 367–374. https://doi.org/10.3109/10641955.2012.690056

Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., Gonzalez-Medina, D., Barber, R., Huynh, C., Dicker, D., Templin, T., Wolock, T. M., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., Abubakar, I., Achoki, T., Adelekan, A., Ademi, Z., Adou, A. K., … Lozano, R. (2014). Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England), 384(9947), 980–1004. https://doi.org/10.1016/S0140-6736(14)60696-6

Krishnamurti, T., Simhan, H. N., & Borrero, S. (2020). Competing demands in postpartum care: a national survey of U.S. providers' priorities and practice. BMC health services research, 20(1), 284. https://doi.org/10.1186/s12913-020-05144-2

Laureij, L. T., van der Hulst, M., Lagendijk, J., Been, J. V., Ernst-Smelt, H. E., Franx, A., & Lugtenberg, M. (2021). Insight into the process of postpartum care utilisation and in-home support among vulnerable women in the Netherlands: an in-depth qualitative exploration. BMJ open, 11(9), e046696. https://doi.org/10.1136/bmjopen-2020-046696

Lockwood, C. J. (2019). Preventing maternal mortality. Contemporary OB/GYN. https://www.contemporaryobgyn.net/view/preventing-maternal-mortality

Miller, H. E., Do, S. C., Cruz, G., Panelli, D. M., Leonard, S. A., Girsen, A., Lee, C. J., Khandelwal, A., Shaw, K. A., & Bianco, K. (2022). Addressing postpartum contraception practices utilizing a multidisciplinary Pregnancy Heart Team approach. AJOG global reports, 2(4), 100100. https://doi.org/10.1016/j.xagr.2022.100100

Miller, H. E., Sie, L., Lee, C. J., Panelli, D. M., Sherwin, E. B., Noon, B., Girsen, A., & Bianco, K. (2020). 1149: Contraception uptake among women with cardiovascular disease: The impact of a multidisciplinary team care approach. American Journal of Obstetrics & Gynecology, 222(1), S707-S708. https://doi.org/10.1016/j.ajog.2019.11.1161

Moaddab, A., Dildy, G. A., Brown, H. L., Bateni, Z. H., Belfort, M. A., Sangi-Haghpeykar, H., & Clark, S. L. (2018). Health Care Disparity and Pregnancy-Related Mortality in the United States, 2005-2014. Obstetrics and gynecology, 131(4), 707–712. https://doi.org/10.1097/AOG.0000000000002534

Moussa, H. N., & Rajapreyar, I. (2019). ACOG Practice Bulletin No. 212: Pregnancy and Heart Disease. Obstetrics and gynecology, 134(4), 881–882. https://doi.org/10.1097/AOG.0000000000003497

O'Kelly, A. C., Michos, E. D., Shufelt, C. L., Vermunt, J. V., Minissian, M. B., Quesada, O., Smith, G. N., Rich-Edwards, J. W., Garovic, V. D., El Khoudary, S. R., & Honigberg, M. C. (2022). Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women. Circulation research, 130(4), 652–672. https://doi.org/10.1161/CIRCRESAHA.121.319895

One Health Trust. (2020). Worldwide Maternal Mortality Rates. Centers for Disease Control and Prevention, National Vital Statistics System; World Health Organization, The Center for Disease Dynamics, Economics & Policy. https://onehealthtrust.org/publications/infographics/worldwide-maternal-mortality-rates/

Padron, E., Sherwin, E. B., Louis-Jacques, K. S., Munoz, Y. F., Dominguez, L. V., Parameshwar, P., Ramirez, N. J., Iweakogwu, I., Panelli, D. M., Khandelwal, A., & Bianco, K. (2025). (180) The Unmet Needs of Patients with Cardiac Disease in the Fourth Trimester: a mixed-methods study. SMFM2025 Pregnancy Meeting, Jan. 27-Feb. 1, Denver, Colorado.

Panelli, D. M., & Bianco, K. (2022). Cellular aging and telomere dynamics in pregnancy. Current opinion in obstetrics & gynecology, 34(2), 57–61. https://doi.org/10.1097/GCO.0000000000000765

Ramirez, N. J., Panelli, D. M., Padron, E., Dominguez, L. V., Lee, C. J., Mayo, J., Khandelwal, A., & Bianco, K. (2022). Effects of Adverse Childhood Experiences on Perinatal Outcomes in Patients with Cardiac Disease: A Pilot Study. Reproductive Sciences, Springer, 30.

Regitz-Zagrosek, V., Roos-Hesselink, J. W., Bauersachs, J., Blomström-Lundqvist, C., Cífková, R., De Bonis, M., Iung, B., Johnson, M. R., Kintscher, U., Kranke, P., Lang, I. M., Morais, J., Pieper, P. G., Presbitero, P., Price, S., Rosano, G. M. C., Seeland, U., Simoncini, T., Swan, L., Warnes, C. A., … ESC Scientific Document Group (2018). 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. European heart journal, 39(34), 3165–3241. https://doi.org/10.1093/eurheartj/ehy340

Silversides, C. K., Grewal, J., Mason, J., Sermer, M., Kiess, M., Rychel, V., Wald, R. M., Colman, J. M., & Siu, S. C. (2018). Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study. Journal of the American College of Cardiology, 71(21), 2419–2430. https://doi.org/10.1016/j.jacc.2018.02.076

Siu, S. C., Sermer, M., Colman, J. M., Alvarez, A. N., Mercier, L. A., Morton, B. C., Kells, C. M., Bergin, M. L., Kiess, M. C., Marcotte, F., Taylor, D. A., Gordon, E. P., Spears, J. C., Tam, J. W., Amankwah, K. S., Smallhorn, J. F., Farine, D., Sorensen, S., & Cardiac Disease in Pregnancy (CARPREG) Investigators (2001). Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation, 104(5), 515–521. https://doi.org/10.1161/hc3001.093437

Tanous, D., Siu, S. C., Mason, J., Greutmann, M., Wald, R. M., Parker, J. D., Sermer, M., Colman, J. M., & Silversides, C. K. (2010). B-type natriuretic peptide in pregnant women with heart disease. Journal of the American College of Cardiology, 56(15), 1247–1253. https://doi.org/10.1016/j.jacc.2010.02.076

Tolani, A. T., Do, S. C., Blumenfeld, Y. J., Sie, L., Girsen, A. I., Lee, C. J., Sherwin, E. B., Tsur, A., El-Sayed, Y. Y., Khandelwal, A., & Bianco, K. (2019). 819: Care of the pregnant cardiac patient — the importance of a multidisciplinary approach. American Journal of Obstetrics & Gynecology, 220(1), S536. https://doi.org/10.1016/j.ajog.2018.11.842

Valdes, A. M., Andrew, T., Gardner, J. P., Kimura, M., Oelsner, E., Cherkas, L. F., Aviv, A., & Spector, T. D. (2005). Obesity, cigarette smoking, and telomere length in women. Lancet (London, England), 366(9486), 662–664. https://doi.org/10.1016/S0140-6736(05)66630-5

Wang, K., Liu, H., Hu, Q., Wang, L., Liu, J., Zheng, Z., Zhang, W., Ren, J., Zhu, F., & Liu, G. H. (2022). Epigenetic regulation of aging: implications for interventions of aging and diseases. Signal transduction and targeted therapy, 7(1), 374. https://doi.org/10.1038/s41392-022-01211-8

Weischer, M., Bojesen, S. E., & Nordestgaard, B. G. (2014). Telomere shortening unrelated to smoking, body weight, physical activity, and alcohol intake: 4,576 general population individuals with repeat measurements 10 years apart. PLoS genetics, 10(3), e1004191. https://doi.org/10.1371/journal.pgen.1004191

Werner, C. M., Hecksteden, A., Morsch, A., Zundler, J., Wegmann, M., Kratzsch, J., Thiery, J., Hohl, M., Bittenbring, J. T., Neumann, F., Böhm, M., Meyer, T., & Laufs, U. (2019). Differential effects of endurance, interval, and resistance training on telomerase activity and telomere length in a randomized, controlled study. European heart journal, 40(1), 34–46. https://doi.org/10.1093/eurheartj/ehy585

NURSING:
1. Campiño-Valderrama, S. M., Duque, P. A., & Garcés-Gómez, Y. A. (2024). Nursing education strategy for caregivers of children and adolescents with epilepsy. Epilepsy & Behavior, 161, 110035.
2. Lee, J. H., Ju, H. O., & Lee, Y. J. (2019). Effects of an algorithm-based education program on nursing care for children with epilepsy by hospital nurses. Child Health Nursing Research, 25(3), 324.

PHYSICIAN ASSOCIATE:
1. James, H. E., MacGregor, T. L., Postlethwait, R. A., Hofrichter, P. B., & Aldana, P. R. (2012). Advanced registered nurse practitioners and physician assistants in the practice of pediatric neurosurgery: a clinical report. Pediatric neurosurgery, 47(5), 359-363.
2. Gee, A. L., & Gee, A. (2018). Filling the gap in pediatric neurology. Practical Neurology, 60-63.

For activity related questions, please contact
     Name: Holly Meyer
     Title: Compliance Coordinator
     Email: [email protected]

For CME general questions, please contact 
 
   Email: [email protected]



Mitigation of Relevant Financial Relationships


Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education.

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity.



Member Information
Role in activity
Nature of Relationship(s) / Name of Ineligible Company(s)
Faculty Photos
Ruth Adewuya, MD
Managing Director
Stanford University
Course Director
Nothing to disclose
Faculty Photos
Y. Katherine Bianco, MD
Clinical Professor, Obstetrics & Gynecology - Maternal Fetal Medicine
Stanford University
Faculty
Nothing to disclose

Maternal Cardiac Health: Improving Outcomes and Lifelong Cardiovascular Care Recording Module
INSTRUCTIONS:  Click the Launch Video button to watch the recording. Next, click the Claim CE button. Attest to your participation, view results and complete the evaluation. After successful completion, your credit transcript will be available to view and download immediately in My CE portal. 

Can’t find the evaluation? Click the My CE button and select the Evaluation and Certificates tile. Select the Complete Evaluation button associated with the activity.
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