Melanie Cole, MS (Host): Welcome to UAMS Health Talk with the specialists from the University of Arkansas for Medical Sciences. Today, we're highlighting the UAMS Health Cardio-Obstetrics Program, saving mothers' lives. I'm Melanie Cole. And joining me is Dr. Taylor Ghahremani. She's a perinatologist at the University of Arkansas for Medical Sciences.

Dr. Ghahremani, thank you so much for joining us today. For people who may not be so familiar with that term cardio-obstetrics, tell us a little bit about what that means and why it's important for pregnant and even postpartum women.

Taylor Ghahremani, MD: Absolutely. Thank you so much for having me. So, cardio-obstetrics encompasses a true multidisciplinary approach to pregnancy care as well as postpartum care for women who have either preexisting cardiovascular conditions or that which develops as a result of or during the pregnancy itself. And this is a really important topic, because cardiovascular disorders remain one of the leading causes of mortality pregnancy-related mortality rather, for women in Arkansas and the United States. And in general, cardiovascular disease is still the number one killer of women overall.

Melanie Cole, MS: So this is a relatively new specialty. Am I correct about that? I mean, the need has been around for a long time, but this is relatively new

Taylor Ghahremani, MD: I agree. The need has been around for a long time. The concept of these specialized approaches to care have been around for a while, but I think we are paying more attention to it now really because of this rise in pregnancy-related mortality related to cardiovascular disease.

Melanie Cole, MS: So, tell us about the UAMS Cardio-Obstetrics program, Dr. Ghahremani. What gap is it designed to fill, and how does bringing together, as you mentioned, multidisciplinary is what's so important here, how does that really change the care for patients?

Taylor Ghahremani, MD: Absolutely. Well, like I mentioned, you know, we know that there is a need for this type of specialized approach. But in our state, there is also some access and geography issues that patients in rural communities face. And asking at-risk mothers to come to multiple subspecialty appointments, I think, is a big ask.

So, what we were able to accomplish with the cardio-obstetrics program is really bringing together the maternal-fetal medicine consultation with an advanced heart failure or a cardiology specialist appointment that can happen not only all under one roof, but sometimes accomplishing quite a bit in just one appointment.

And through this program, we are able to offer moms a complete cardiac assessment with lab work, echocardiogram, EKG, as well as an exam by one of our advanced heart failure specialists. And then, of course, like I mentioned, you also get the maternal fetal medicine input for how we will manage the remainder of pregnancy.

Following that appointment, we sort of bring this information back to an even larger multidisciplinary panel that also includes our obstetric anesthesiology team, our intensive care unit physicians as well, so that we can help coordinate and plan, all the way through pregnancy, labor, delivery, as well as that postpartum course.

Melanie Cole, MS: That's really comprehensive. So when we think of the conditions that women can get, diabetes, high blood pressure, some of which they had before they got pregnant and some of which can develop during pregnancy, preeclampsia and other cardiovascular risk factors, Doctor. So, how do these potentially affect her long-term health and indeed her pregnancy as it progresses?

Taylor Ghahremani, MD: Yes. So, you know, preeclampsia does incur a fourfold higher risk of cardiovascular disease for women in their entire life, including after pregnancy, of course. So, this is something that we all want to pay really close attention to.

As far as prevention goes, there are some tactics that we can employ, and I think that OBs around the state are doing a really great job of this right now. And something as simple as starting a low-dose once-a-day aspirin during the pregnancy starting between 12 and 16 weeks for women who are at risk for developing preeclampsia. This has been shown to reduce the rates of preterm preeclampsia. And again, this is a low-cost, but highly efficient way to lower that risk for these moms.

You also mentioned diabetes. So, you know, when we talk about diabetes in pregnancy, there are those that have preexisting diabetes coming into the pregnancy, which we also have a fabulous program for at the University of Arkansas for Medical Sciences, and then gestational diabetes as well.

Gestational diabetes does incur about a 70% risk of progression to type 2 diabetes later in life. So again, when we're talking about risk stratification for cardiovascular disease, identifying these women before but also during the pregnancy allows us to sort of make a plan that goes beyond pregnancy care so that we can set these women up for success and longevity for their life.

Melanie Cole, MS: Doctor, you mentioned before some of the challenges in rural communities. So, how does geography and access factor in to what you're seeing in Arkansas and particularly for women in those rural communities and underserved communities? Tell us a little bit about how that works and how this is really so helpful for those women.

Taylor Ghahremani, MD: Absolutely, yes. So, patients in our state who have to travel long distances to access either routine OB care or subspecialty care like maternal fetal medicine or cardiology do have some unique challenges, especially in cases of more urgent or emergent situations.

That being said, we do have some programs in place through the high-risk pregnancy program where we can offer telemedicine consultations. For patients who need maternal fetal medicine care, they can go to a local unit to have a detailed ultrasound and then again a telemedicine maternal fetal consultation rather. We are hoping to also extend in the near future the telemedicine access to maternal echocardiography, which is a detailed assessment of the maternal heart structure and function.

So, almost bringing our cardio-obstetrics program on the road to these remote access locations around the state I think will just further improve the health and outcomes of moms and babies.

Melanie Cole, MS: That really is fascinating, Doctor. So, you did some research involving pregnancy care and maternal health. What have you learned through the work that has changed the way that you think about caring for patients?

Taylor Ghahremani, MD: Yes. So, evidence-based medicine is a really big part of my practice. Research is an important part of what I do. That being said, I think it's always really important to remember that the patients that I take care of are not just numbers, statistics, right? These are my friends, my neighbors, my coworkers, right?

So, just utilizing the research to improve outcomes for moms and their babies is so important, but also remembering that we want to treat them with the kindness and respect that every patient deserves

Melanie Cole, MS: Well, that's certainly true. And over the years, we've seen that one of the challenges in maternal health is really translating that research into everyday practice. Take us from bench to bedside. How do you feel that what you've learned can really turn into applicable clinical practice for Arkansas?

Taylor Ghahremani, MD: Absolutely. You touched on it. You know, it is sometimes challenging to take the research off the bench and get it into the hands of patients and providers. It doesn't always happen very quickly. That being said, UAMS does have some other great systems in place that are helping combat this.

Right now, we host a weekly teleconference that is broadcasted to OB care providers throughout the state, as well as those in Eastern Oklahoma. This is the high-risk OB teleconference. And what we are doing in that conference is going over high-risk pregnancy conditions, how to manage them, how to treat them, and then also talking about any new developments that have come off of newly printed research.

Melanie Cole, MS: Doctor, you've given us so much great information, and what a great program. It's so important for women listening that they know that that maternal health care is out there for them. What do you want women and the healthcare professionals caring for them to know about the importance of cardiovascular health before pregnancy, during pregnancy, and even after?

And for those women, what's your best advice about being their own best health advocate? Because as we know, Doctor, we women, we're the caregivers to society. And if we don't put our own mask on, certainly we can't take care of those that we love. So while you're telling us about how cardiovascular risk factors into pregnancy and post-pregnancy, what do you want us to know about speaking up, asking questions, trusting our instincts, and being our own best health advocate?

Taylor Ghahremani, MD: All of those things are so important to pregnancy care and beyond. What I would want women to know is you should really understand your risk even before pregnancy starts, because there are some things that are modifiable risk factors that can really impact the health of your pregnancy.

These are things like obesity. This is a major modifiable risk factor for cardiovascular disease as well as gestational diabetes, preeclampsia. So, knowing that risk before pregnancy. During pregnancy, understand what are some ways we can combat that risk. Talk to your OB providers. Like I mentioned earlier, we have some very low-cost, but highly effective ways to reduce risk for things like preeclampsia, such as starting a low-dose aspirin at 12 to 16 weeks durIng the pregnancy.

The other thing I would want providers to know is they are already doing a lot of the risk stratification from the very first prenatal visit. At every prenatal visit, patients are getting their blood pressure taken, pulse as well as a BMI calculation through their height and weight. And that objective data right there is a really great way to understand using the pregnancy as a window into the patient's future health.

And I always say that, you know, pregnancy is a very unique time. There is no other time in a woman's life where she will have a doctor's visit every one to four weeks for nine months in a row, right? And so, again, just the concept of using all of that data that we receive and how the pregnancy condition is and using that to look into her lifelong health.

Postpartum in any patients who are at risk for cardiovascular disease or diabetes later in life should be referred to primary care physicians, hopefully in their local communities. So, there's that ease of access like we talked about earlier. And so, again, I would just really promote patients and also physicians to really look at pregnancy as a nice window into the future.

Melanie Cole, MS: Well said. Thank you so much, Dr. Ghahremani, for joining us today and giving us such great information about the cardio-obstetrics program at UAMS and about really those risk factors that women need to take into account and the importance of taking care of their health. Thank you so much for joining us today and sharing your incredible expertise.

And you can always visit our website at uams.edu for more information and to get connected with one of our providers. That wraps up this episode of UAMS Health Talk from the University of Arkansas for Medical Sciences. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library.