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Behind Merck's advocacy for cardiac disease in pregnancy

Merck for Mothers invests in developing industry-leading, evidence-based clinical standards aimed at addressing cardiac disease in pregnancy.

Sara Heath
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Published: 09 Sep 2024

At Merck for Mothers, the goal is strategic grantmaking and support to deliver on evidence-based standards of care that will ideally help chip away at the nation's maternal health problems. Most recently, the organization set its sights on cardiac disease in pregnancy.

"We've been really fortunate through Merck for Mothers to be able to support a number of solutions that are focused on trying to advance towards that standardization so that everyone is receiving care that is high-quality, safe, respectful and equitable regardless of where they're seeking care across the pregnancy and childbirth continuum," according to Jacquelyn Caglia, director of Merck for Mothers.

Patient access to standardized, adequate maternity care might not sound like a tall order, but in the U.S., it is.

The nation is home to the worst maternal health outcomes and maternal health disparities in the developed world, according to data from the Commonwealth Fund. According to the CDC, one in five women has had a bad maternity care experience.

Merck for Mothers sets out to address those problems by advocating for better maternal health outcomes and putting their money where their mouth is -- literally. Through strategic grantmaking, the organization has reached nearly 30 million patients worldwide.

Most recently, the organization has zeroed in on cardiovascular disease (CVD) risk among pregnant people.

"Pregnancy can be sort of like a stress test or a person's heart," Caglia explained in an interview.

Pregnancy prompts a lot of normal biological processes in the body, but that can still put a lot of strain on an individual's heart muscle. This can provide an indication related to pregnancy complications or a complication that might have developed as part of someone's lifelong health.

Right now, the U.S. is staring down the barrel of a growing maternal mortality problem, with a February 2024 article in the journal Circulation showing a 140% increase in pregnancy-related deaths over the past three decades, of which CVD is a leading cause.

Segmented out further, data shows serious health disparities in cardiac disease in pregnancy.

"When we stratify the data across the U.S. by race and ethnicity, we see differences at a population level," according to Caglia. "And for Black and Indigenous women across the U.S., it's actually cardiovascular complications that rise to the tippy top of the list."

"From a health equity perspective, it's really important that we have strong data sets across the U.S. in order to understand where there may be particular vulnerabilities within populations so that we can target our screening, target our interventions and support provider education around that in order to get to an accurate diagnosis of complications or support that might be needed."

The risk of maternal complications due to cardiac disease in pregnancy is enough to prompt Merck for Mothers to invest in solutions.

"With pregnancy and childbirth being a normal biological process, it really is helpful to understand that the need to keep an eye on someone's heart health during pregnancy and childbirth is really critical, both for the outcome of the pregnancy as well as the health of the mother or the pregnant person in the long-term," Caglia said.

Making a difference through grantmaking partnerships

Merck for Mothers views itself as a convener of resources and expertise, helping to prop up various healthcare sector players in their work to improve maternal health outcomes, according to Caglia.

That's what led the organization to partner with the American Heart Association (AHA) on a set of standards to address cardiac disease in pregnancy. The standards, published in May of 2024, call for the following:

  • Comprehensive health insurance coverage through the first 12 months following birth.
  • Standardized provider education for all healthcare professionals who might meet with a pregnant or postpartum patient.
  • Patient-centered care strategies that engage a multidisciplinary care team, including midwives, doulas, mental healthcare providers, community health workers and other relevant healthcare professionals.
  • Monitoring of maternal risk factors, including screening for cardiovascular risk factors such as blood pressure, fasting lipid panels, weight and glucose intolerance/diabetes and other biomarkers, during preconception and interconception.

AHA convened a group of maternal and cardiovascular health experts to develop the standards, a fact Caglia said attracted Merck to the project in the first place.

"It really comes down to trying to pull together all of the most trusted voices in order to make advances in patient education and provider education," she explained.

"The benefit of being able to support the work of a very well-known, established organization like the American Heart Association really comes from their convening power of being able to bring together our country's leading experts on cardiovascular health and maternal health in order to create consensus and recommendations related to the most effective ways to address cardiovascular conditions around pregnancy."

In fact, that's what drives much of Merck for Mothers' grantmaking work. The organization is interested in funding expert-led projects that follow the evidence. For example, Merck for Mothers is currently exploring programs that promote access to postnatal care, which is the care a person receives after labor and delivery for the full year after the baby is born.

Caglia said her team knows that more than 50% of deaths and complications are showing up after childbirth.

"The way that our care system is structured in the U.S. related to postnatal care is that we don't yet have very robust standards for that full first year," she noted. "Oftentimes, a person who is welcoming a new baby into their family usually will have a visit and a checkup sometime between four and six weeks."

By tailoring its grantmaking toward these maternal health needs, Merck for Mothers intends to move the needle on better maternal outcomes.

Notably, assessing these needs requires an evidence-based approach, Caglia said. While Merck for Mothers is committed to following the data, the organization also knows it needs to strongly engage patients, caregivers and advocates to truly get to know the biggest pain points and tailor grant funding to address health equity.

Engaging communities to support health equity

Merck for Mothers can't make grantmaking decisions in a vacuum. In addition to a data-driven approach, the organization needs to hear from the patients, their caregivers and their advocates about how to reimagine a better maternal health landscape.

"We really take an approach to health equity that is about centering the people most proximate to the issues that we're trying to solve for," Caglia noted.

"One of our strategies with our grantmaking has really been investing at a systems level in working to strengthen our national system of being able to engage patients and families and advocates and people with lived experience in designing the programs and policies and solutions that will ultimately make a difference in allowing optimal maternal health outcomes to be equitable and available to all."

That's what has driven some of Merck's work with postnatal care, for example.

While the organization observed the high maternal mortality rate after labor and delivery, Merck for Mothers was driven further by the perspectives of the communities most affected. Through community and patient engagement, the organization has been able to identify a greater need for more clinical, social and emotional support for postpartum people.

Ultimately, these funding opportunities are intended to make their way into the clinician office, where individual healthcare providers can change maternal healthcare for the better. Through provider education about effective maternity care standards, healthcare providers can make meaningful improvements for their patients, Caglia concluded.

Sara Heath has covered news related to patient engagement and health equity since 2015.

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