Native American Pregnant Women’s Heart Health: Expert’s View
6 min read
Heart disease is the top cause of death for U.S. adults. And for American Indian/Alaska Native (AI/AIN) women, the risk is particularly high during pregnancy and spans generations.
To help lower that risk, the American Heart Association (AHA) recently released its first set of scientific guidelines for cardiovascular health in American Indian/Alaska Native (AI/AN) women of childbearing age.
The guidelines address well-known risk factors such as high blood pressure, LDL cholesterol levels, type 2 diabetes, obesity, and smoking. But they go beyond that to include trauma and mistrust passed down for centuries.
Jason Deen, MD, is one of the experts who wrote the new guidelines. He is a UW Medicine pediatric cardiologist who practices at Seattle Children’s Hospital and directs the Indian Health Pathway at University of Washington (UW) Medicine.
“My mother is Blackfeet, so I’m a Blackfeet descendent,” Deen says. “She talked to me at a very early age about the health care differences she saw growing up in Montana. So I got into medicine very early and was interested in working in Native health. “
During medical training in Minnesota, he recalls seeing “young Native kids with adult heart risk factors” such as obesity, high cholesterol, and high blood pressure. That was “the usual” for those patients, Deen says. And on call at night, he noticed that AI/AN adults were having cardiovascular emergencies “sometimes a decade earlier than other races,” Deen says. “In my mind, the two things were linked: that cardiac disease in young folks tracks to adulthood and leads to premature disease.”
Cardiovascular disease is the top cause of pregnancy-related death in the U.S., and American Indian/Alaska Native women have the second highest rate of maternal mortality, according to a study published in The Journal of the American Medical Association in July 2023.
Although there hasn’t been a lot of research on this group, the AHA group found several measurable targets that may make a difference. They are what the AHA calls “Life’s Essential 8”:
- Eat better.
- Be more active.
- Quit tobacco.
- Get healthy sleep.
- Manage weight.
- Control cholesterol.
- Manage blood sugar.
- Manage blood pressure.
If those sound familiar, they should. They’re “very well-known, modifiable health risk factors that need to be focused on when you’re thinking about cardiovascular disease prevention,” Deen says. These factors apply to people of all backgrounds.
For AI/AN communities, there’s another layer to the guidelines. It’s about “trying to address intergenerational trauma,” Deen says, and “mistrust” in the U.S. government, physicians, and the research community.
Consider these facts from the AHA’s report:
- 60% of AI/AN women already have “suboptimal” heart health when they become pregnant.
- Risk factors including type 2 diabetes,
