How maternal fetal medicine specialists improve outcomes for high-risk pregnancies

In a recent interview with Contemporary OB/GYN, Angela Bianco, MD, a maternal fetal medicine expert and director at Mount Sinai Health System, discussed how specialists in this field can support high-risk pregnancies.

Bianco began by addressing concerning trends in maternal mortality in the United States. Among industrialized nations, the United States has one of the highest maternal mortality rates. While there has been a slight decline overall, this improvement is not reflected among women of color, particularly Black and Brown pregnant individuals. She highlighted that this disparity is alarming for obstetricians and health care providers committed to comprehensive maternal care.

The leading causes of maternal mortality in the United States include cardiovascular disorders, particularly hypertension, peripartum hemorrhage, and self-harm. These conditions disproportionately affect women of color, especially Black women, contributing to the overall maternal death rate.

Bianco explained that maternal fetal medicine specialists play a crucial role in addressing these disparities and reducing risks in high-risk pregnancies. The issue is multifaceted, influenced by social determinants of health, health care access, and, the lack of trust many Black and Brown patients have in the health care system. She emphasized that health care professionals must establish strong, trusting relationships with patients early on to improve outcomes.

To address these challenges, a multi-pronged approach is necessary. One significant step is diversifying the health care workforce to ensure better representation and cultural understanding. Additionally, Mount Sinai has implemented a comprehensive doula program, as research shows that doulas can improve obstetric outcomes by providing continuous, culturally competent support throughout pregnancy, labor, and postpartum care. Ensuring that patients have relatable, trusted support figures can enhance their overall care experience and outcomes.

Another critical aspect of improving care is adopting a systematic, algorithmic approach to treating high-risk conditions such as hypertension, hemorrhage, and psychosocial disorders. Standardized protocols can help clinicians respond effectively to complications, ultimately reducing maternal morbidity and mortality.

For clinicians caring for high-risk pregnant patients, Bianco stressed the importance of establishing trust early in the patient-provider relationship and advocating for a multidisciplinary approach. Ensuring that patients remain engaged with the health care system and receive necessary resources for both physical and mental health is key to improving outcomes.

In closing, Bianco highlighted the need for collaboration across medical specialties, midwifery, and doula services at national, state, and local levels. By working together and addressing systemic gaps in maternal care, health care providers can make significant progress in reducing maternal health disparities in the United States.