Leading heart disease and pregnancy expert speaks on maternal mortality
James Nello Martin, MD, Professor & Vice Chair Emeritus of Obstetrics and Gynecology and Maternal-Fetal Medicine at the Winfred L. Wiser Women’s Hospital of the University of Mississippi Hospitals, delivered a highly informative presentation on heart disease and pregnancy to the Ob/Gyn department at the annual Sree Gaddipati, MD Memorial Lecture on May 16, 2019.
Dr. Martin’s presentation, Maternal Mortality: It’s a Matter of the Heart, shared the top ten takeaways from the American College of Obstetricians and Gynecologists (ACOG) 2018-2019 Presidential Task Force on Pregnancy and Heart Disease. The presentation focused on rising rates of maternal mortality, a significant percentage of which can be attributed to cardiovascular causes, particularly in cases more than one month postpartum. While the rates of hemorrhage, infection, and hypertensive disorder that typically impact women at time of delivery have declined in the past 30 years, rates of pregnancy-related deaths caused by cardiomyopathy and cardiovascular conditions, which typically impact women postpartum, have dramatically increased.
Dr. Martin attributes this to a rise in acquired heart disease, owing to factors like maternal age and obesity, rather than congenital heart disease. Non-Hispanic black women are also more than three times as likely to die from cardiovascular disease-related pregnancy complications.
Throughout the presentation, Dr. Martin outlined specific, actionable takeaways on pregnancy and heart disease from his year on the committee as well as his long experience as an Ob/Gyn in Mississippi. He identified risk factors to be aware of in patients and what signs or triggers to look out for in a patient’s condition that indicate she is at risk for a cardiovascular condition during pregnancy or postpartum.
"Think about cardiovascular disease in all of your pregnant patients,” Dr. Martin said.
In order to tackle rising rates of cardiovascular-related maternal deaths, Dr. Martin advocated for a re-envisioning of how the medical establishment views the postpartum period, and how patients are cared for during this time.
"Once the pregnancy is over, it's not over for the patient who has preeclampsia or cardiovascular disease,” Dr. Martin said. “The old thinking about a postpartum visit at six weeks and then you're out of there is defective thinking. We advocate that women at risk for cardiovascular disease should be evaluated at 12 weeks as well. You need to consider postpartum care for up to six months.”
In continuing to decrease rates of hemorrhage and cardiac arrest during delivery, Dr. Martin said simulation training is crucial.
"You don't have time to read the book when a patient has cardiac arrest,” he said. “You need to be prepared, so simulation plays a very important role for Ob/Gyns.”
This annual Sreedhar Gaddipati, MD lecture is dedicated to the legacy of Dr. Gaddipati, who was, and remains, an important figure in the Columbia University Vagelos College of Physicians and Surgeons medical education program. The lecture was established by a generous donation from the Gaddipati family to honor this exceptional teacher and role model, esteemed and beloved physician, revered colleague, and dear friend to the department, who passed away unexpectedly on August 7, 2013.
Dr. Gaddipati joined Columbia University in 2003 as a Clinical Assistant Professor in Maternal-Fetal Medicine and became the Director of Critical Care Obstetrics. He received numerous teaching awards and honors, including the Council on Resident Education in Obstetrics and Gynecology National Faculty Award for Excellence in Resident Education in 2000, 2003, and 2005.
Jim Martin, MD is Professor & Vice Chair Emeritus of Obstetrics and Gynecology and Maternal-Fetal Medicine at the Winfred L. Wiser Women’s Hospital of the University of Mississippi Hospitals and Clinics in Jackson, Miss., where he worked from 1981 through the end of 2014. His primary focus was on hematologic and hypertensive complications of pregnancy.
Dr. Martin has contributed to approximately 800 scientific publications and communications of various types over the past 45 years. He is a past president of the Society for Maternal-Fetal Medicine and the American College of Obstetrics and Gynecology. Among his awards is the Hope Award from the Preeclampsia Foundation in 2009, selection as a Distinguished Medical Alumnus of the University of North Carolina, the Lifetime Achievement Award from SMFM, election to the University of Mississippi Medical Alumni Hall of Fame, and named in 2017 a Legend in Mississippi Obstetrics & Gynecology by the Mississippi Section of ACOG. He has contributed to the professional education and clinical/surgical training of the majority of Ob/Gyns now in practice in Mississippi as well as approximately 40 MFM subspecialists who practice throughout the United States.
Now retired from active clinical practice, Dr. Martin continues an active professional life teaching, consulting, researching, writing, and working with numerous professional organizations. Currently he co-chairs the Mississippi Maternal Mortality Review Committee and chairs the ACOG 2018-2019 Presidential Task Force on Pregnancy & Heart Disease.
