CMOs Need to Brace for More High-Risk Pregnancies. Here’s How.
By Christopher Cheney
High-risk pregnancies are increasing, and CMOs need to put resources in place to address them.
Hospitals in Florida are forecasting a 14.5% increase in high-risk pregnancies over the next decade, and the trend is expected to be nationwide. According to Cleveland Clinic, the causes of high-risk pregnancies include pre-existing conditions in women such as diabetes, high blood pressure, and obesity, as well as pregnancy-related health conditions such as gestational diabetes, low birth weight, and preeclampsia.
There is no doubt that high-risk pregnancies are increasing, according to Mert Bahtiyar, MD, director of the Fetal Care Center at Yale New Haven Children’s Hospital. On the maternal side, there are patients with increased high-risk factors such as high body mass index, chronic hypertension, previous surgeries, and malignancies. From the babies’ perspective, there are more high-risk factors, including genetic and structural abnormalities.
“We look after two patients, the mother and the baby,” Bahtiyar says. “We are seeing increases in high-risk medical conditions in both populations.”
A CMO should be aware of the trend and the capabilities of their organization to provide care for high-risk pregnancies, Bahtiyar explains.
First and foremost, CMOs need to assemble multidisciplinary care teams to address high-risk pregnancies, according to Bahtiyar.
“There is no single provider who can handle high-risk pregnancies,” Bahtiyar says. “A CMO needs to be aware of the trends in high-risk pregnancies and hire staff accordingly. A CMO needs to support the members of maternal health teams.”
For example, if a congenital heart defect is diagnosed, the care team should include a pediatric cardiologist, a pediatric cardiology surgeon, the staff of a newborn intensive care unit, and care coordinators and patient navigators, Bahtiyar says.
With multiple providers and patient visits involved in high-risk pregnancies, care coordinators and patient navigators are essential members of the care team, according to Bahtiyar.
“With care coordinators and patient navigators, instead of the mother going around to receive care from multiple providers, the care is tailored and organized by the care coordinators or the patient navigators,” Bahtiyar says. “Care coordinators and patient navigators are advocates for the patient.”
High-risk pregnancies and the care for them are evolving, so a CMO must be nimble, Bahtiyar explains.
“Instead of having just a fixed team, a CMO should be willing to adjust the members of the care team and provide in-service training for the team,” Bahtiyar says. “A CMO needs to be adaptive and open-minded.”
High-risk pregnancy services at Yale New Haven Children’s Hospital
Yale New Haven Children’s Hospital provides a range of services when there is a high-risk pregnancy. Bahtiyar cited examples of care that is provided to mothers and their babies.
From the mother’s perspective, if a patient has diabetes, the hospital has a diabetes program from diagnosis to management and handing the patient over to their primary care physician after childbirth. The hospital has a maternal cardiac program that addresses chronic hypertension and other cardiac abnormalities during pregnancy such as congenital heart defects. The cardiac program is a combined program between adult cardiology and maternal obstetrics. The hospital also has a prenatal genetics program.
From the baby’s perspective, the hospital has fetal cardiology services such as fetal echocardiograms. The hospital also has the capacity to perform in utero procedures such as blood transfusions for anemic babies, placing shunts in the abdomen or chest of a baby, and operating on the placenta.
Having services in place for mothers and their babies in high-risk pregnancies is generating positive clinical outcomes, according to Bahtiyar.
“What we know is that controlling diabetes in mothers decreases congenital heart defects in newborns and avoids unnecessary cesarean sections,” Bahtiyar says. “Controlling blood pressure prevents the mother from having cardiovascular incidents during pregnancy.”
“The ability to be able to diagnose and intervene for medical conditions of the fetus in utero improves the outcomes for newborns,” Bahtiyar says. “Recognizing these conditions before childbirth is important, so that we have resources in place at the time of delivery for newborns and their mothers.”