As Say Ahhh! Health Policy Blog readers know, the US rates for maternal mortality and pregnancy-related mortality and severe morbidity are high, with Black and Indigenous women experiencing the highest rates. In 2024, the maternal mortality rate for Black mothers was 44.8 deaths per 100,000 live births, which was significantly higher than the rates for White (14.2), Hispanic (12.1), and Asian (18.1) mothers. Overall, about two-thirds of these deaths occur in the postpartum year, not around the time of birth. While more than 85 percent of maternal deaths are potentially avoidable and preventable, too little is being done to improve outcomes and save lives.
Among pregnancy-related deaths in 2024, cardiovascular conditions accounted for 22.0 percent, hypertensive disorders of pregnancy for 7.7 percent, and stroke for 3.8 percent. The leading cause of maternal mortality for Black mothers are cardiovascular related conditions.
The risks are exacerbated in maternity care deserts. According to the March of Dimes more than 35% of US counties lack providers or hospitals offering obstetric/birth services. Women in these areas travel an average of 2.6 times further to reach a birthing hospital, a delay that can be fatal during a cardiovascular emergency.
At the request of the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), the National Academies of Sciences, Engineering, and Medicine (NASEM) convened experts to identify clinical preventive services that can reduce pregnancy-related cardiovascular morbidity and mortality. The report, Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy, summarizes the research, reports on high priority services, and makes recommendations for federal action.
Clinical Preventive Services Reviewed by the Committee
Clinical preventive services are screenings, counseling, and other interventions designed to identify conditions and risks early, address modifiable factors, and prevent downstream disease and harm. Together, the US Preventive Services Task Force (USPSTF), the Women’s Preventive Services Initiative (WPSI), and Bright Futures have made preventive services recommendations pertaining to overall cardiovascular risk and cardiovascular risk related to pregnancy. Under the Affordable Care Act, recommended preventive services are provided without patient cost-sharing in virtually all private health plans (e.g., employer-based and marketplace plans), as well as by most Medicaid agencies.
Set with a charge to identify gaps, the NASEM committee conducted evidence reviews for nine clinical preventive services that could help to prevent cardiovascular conditions and improve outcomes during the pregnancy and postpartum periods. The set reviewed includes:
1. Blood pressure (BP) thresholds for treatment during pregnancy,
2. Enhanced postpartum hypertension management,
3. Urgent maternal warning signs postpartum,
4. Cardiovascular risk assessment tools in pregnancy and postpartum,
5. Comprehensive cardiovascular health assessment,
6. Telehealth approaches across the reproductive continuum,
7. Integrated cardio-obstetrics care models,
8. Supportive services (doulas, peer navigators, and other community health
workers), and
9. Transitions of care from postpartum to preventive care.
Based on its review, the committee made recommendations for two clinical services with sufficient evidence that should be implemented immediately.
- Prenatal Blood Pressure (BP) Target – Evidence shows that treating chronic hypertension in pregnancy to achieve a BP target of <140/90 mmHg can reduce severe-range hypertension, preeclampsia, preterm birth, and related adverse outcomes. (See Recommendation 1in the report).
- Postpartum Hypertension Management – BP typically peaks 3–7 days postpartum, yet many women do not have an in-person visit until weeks after the end of pregnancy. Enhanced postpartum hypertension management approaches consistently demonstrate increases in early BP assessment, engagement in follow-up care, and improvements in short-term BP control, although studies have not yet demonstrated direct reductions in maternal outcomes. (See Recommendation 3in the report).
While many of the other services reviewed show promise, evidence was limited or insufficient in terms of impact on maternal morbidity or mortality. Often, existing research showed improvements in care processes rather than improvements in maternal health outcomes. Accordingly, the report identifies research priorities to determine which promising services can meaningfully improve health outcomes and are ready for broader implementation. The NASEM committee notes that absence of a recommendation should not be interpreted to mean that a service should not be provided.
Other Recommendations and Challenges
Major barriers to delivery of preventive services to improve maternal heart health and reduce morbidity and mortality include fragmentation in the health care system, limited access to services, and lack of accountability for delivering services. The NASEM committee made recommendations designed to address some of these barriers.
The report recommends that HRSA, working with federal and state partners, support and incentivize systems and programs in order to reduce financial barriers to care, strengthen care transitions, and improve coordination of care across the reproductive life course. Recommendations include, but are not limited to, government actions to:
- Support 12-month postpartum health coverage, with no patient costs for high-priority preventive services and devices.
- Increase capacity to deliver clinical preventive services for pregnancy-related cardiovascular risk by supporting team-based models, embedding core competencies, and aligning workforce incentives across public programs.
- Strengthen the capacity of publicly funded clinics to deliver clinical preventive services for pregnancy-related cardiovascular risk, including support—such as reimbursement, tools, and data systems—for Federally Qualified Health Centers and others that provide prenatal, postpartum and primary care.
- Standardize care transitions immediately following birth, effectively completing referrals and connecting mothers to the next service.
- Expand and standardize maternal health data collection and quality measurement.
- Leverage public programs and grants to expand health education about pregnancy-related cardiovascular risk, the importance of preventive services, and recognition of urgent maternal warning signs.
Many women struggle to gain access to preventive cardiovascular services because of challenges and barriers related to geographic distance, transportation, childcare, work schedules, and fragmented care transitions—particularly in rural and resource-limited communities. Therefore, the report also recommends that government leverage programs for telehealth, rural health, and maternal health to reduce geographic, financial, and system barriers to receipt of preventive cardiovascular services.
REPORT CITATION
National Academies of Science, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. (Editors Any Geller and Tracy A. Lieu). Washington, DC: National Academies Press. https://doi.org/10.17226/29425
OTHER RESOURCES/REFERENCES
Centers for Disease Control and Prevention. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees. April 20, 2026. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc/index.html?cove-tab=2
Centers for Disease Control and Prevention. Data from the Pregnancy Mortality Surveillance System. December 18, 2025. https://www.cdc.gov/maternal-mortality/php/pregnancy-mortality-surveillance-data/index.html
Eugene Declercq and Laurie C. Zephyrin, Maternal Mortality in the United States, 2025 (Commonwealth Fund, July 2025). https://doi.org/10.26099/kdfd-fc19
Hoyert DL. Maternal mortality rates in the United States, 2024. NCHS Health E-Stats. 2026 Mar;(113):1–7. https://dx.doi.org/10.15620/cdc/174651
Susanna L. Trost et al., Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 38 U.S. States, 2020 (Centers for Disease Control and Prevention, May 2024).
Eugene Declercq and Laurie Zephyrin, Severe Maternal Morbidity in the United States: A Primer (Commonwealth Fund, Oct. 2021). https://doi.org/10.26099/r43h-vh76 https://www.commonwealthfund.org/publications/issue-briefs/2021/oct/severe-maternal-morbidity-united-states-primer