NHLBI Community Engagement Technical Assistance Center (CETAC)

Over the past three decades, there have been alarming upward trends in the rates of maternal
morbidity and mortality in the United States. Overall, the identified clinical causes of maternal
death are: cardiovascular conditions (14%), hemorrhage (13%), infection (11%) embolism
(10%), cardiomyopathy (95), mental health conditions (9%) and preeclampsia/eclampsia (8%)
but these conditions vary by race/ethnicity. For Black, non-Hispanic women, the two leading
causes of death were cardiomyopathy and cardiovascular conditions, and mental conditions
was the leading cause among White, non-Hispanic women.1 Obesity, hypertension, smoking,
opioid use and sleep disorders are also conditions and behaviors that have been found to be
associated with maternal morbidity such as hemorrhage, preeclampsia and cardiomyopathy.
These could potentially be addressed in primary care before and between pregnancies.2-6
The National Heart, Lung Blood Institute (NHLBI) is participating in a trans-National Institutes of
Health (NIH) effort to improve women’s health, particularly maternal morbidity and mortality. A
plan – Advancing Science for the Health of Women, The Trans-NIH Strategic Plan for Women’s
Health Research – was developed for the period 2019 – 2023. This plan provides a framework
that recognizes the complex interactions of multiple factors that affect women’s health across
the life course, including pregnancy. Life course theory posits that health development begins
before conception and continues across the life span. It suggests that a complex play of
biologic, behavioral, psychological, and social protective and risk factors contribute to health
outcomes, and that health status reflects the cumulative lifetime exposure to these factors. The
guiding principles for this plan are consideration of the complex factors affecting women’s
health, the inclusion of diverse populations that are disproportionately affected by morbidity and
mortality, and active engagement of a diverse group of scientists.7
The NIH approach to reducing maternal morbidity and mortality will aim to enhance health
disparities research, increase the understanding of social determinants and other risk factors
(including environmental risk factors), improve care (antepartum, intrapartum and postpartum)
and management, provide insight to psychological exposures such as stress, discrimination and
caregiving, understand coping behaviors in families affected by maternal morbidity or mortality,
and investigate the role of implicit bias in the health care systems regarding pregnancy.8 Within
NHLBI, maternal and women’s health priorities span all of the objectives of the NHLBI strategic
vision, and NHLBI has supported a number of maternal health programs looking at
hypertension, sleep disorders, and other pregnancy complications including pre-eclampsia,
eclampsia, and gestational diabetes.
The goal of the NHLBI 3M Administrative Coordinating Center (3M ACC) is to engage
communities and networks in areas that experience high levels of maternal morbidity and
mortality. The 3M ACC will support the preliminary work necessary to identify and prepare a
group of community-based organizations to respond to future funding opportunities. The 3M
ACC will develop the infrastructure to support this group of Maternal Morbidity and Mortality
Regional Coalitions (3M RCs) and provide scientific support and coordination to NHLBI on
emerging scientific needs. Specifically, the 3M ACC will support these programmatic objectives:
• Identify research groups and organizations with existing and relevant expertise and
community partnerships.
• Conduct landscape analyses and community-informed needs assessments.
• Identify within each community implementation opportunities and barriers to improve
delivery of evidence-based care to reduce maternal morbidity and mortality.
• Develop and conduct early-stage tests of implementation approaches to identify potential
strategies to ensure the proposed approaches are acceptable, feasible, scalable, and
sustainable and to identify barriers.

Grant Number: 3OT2HL158287-01SD
NIH Institute/Center: NIH
Principal Investigator: Chanza Baytop