Counseling, Care Models, and Community Pharmacists’ Role in Supporting Pregnant, Lactating Patients With Heart Disease

This panel, part of an American College of Cardiology (ACC) initiative, features moderator Jessie Dunne, PharmD, BCPS, BCCP, FACC, a clinical pharmacist at Oregon Health & Science University, as well as panelists:

• Kayle Shapero, MD, PhD, a cardiologist at Brown University Health and assistant professor of medicine at Brown University's Warren Alpert Medical School;
• and Ashley Schenk, PharmD, AACC, BCCP, BCPS, a cardiology clinical pharmacist at University of Kentucky (UK) HealthCare and an adjunct assistant professor at the UK College of Pharmacy.

In this final segment, the panelists discuss how to talk with patients about medication risks without causing alarm. Shapero says that approaches should depend on the individual patient—some may want the primary literature, and she has shared case reports on β-blocker use with patients who found the detail reassuring. She stresses that the conversation must be honest about the risk of cardiac deterioration, and that a healthy baby depends on a healthy mother. Schenk shares her own experience: she had a reduced ejection fraction during her first pregnancy that recovered after delivery. She says close follow-up and providers who told her the finding was not rare helped put her mind at ease.

Shapero also describes the multidisciplinary cardio-obstetrics clinic as the model that many institutions are working toward. In this model, maternal-fetal medicine specialists and cardiologists work alongside pharmacists, social workers, nurses, and anesthesiologists to care for patients from preconception through the postpartum period. She notes that this model requires substantial resources and is usually limited to larger centers, stating that maternity care deserts in rural areas may not have these resources; however, she notes there is proposed legislation that would expand telehealth access to maternal-fetal medicine and obstetric specialists within these areas.

Dunne, who grew up in a rural community where a family medicine physician provided nearly all care, urges community pharmacists—especially in rural areas—to learn about the needs of these patients, to reinforce safe medication use, and to build connections with specialists they can consult. Shapero and Schenk agree on the main takeaway: Pharmacists do not need to be experts in pregnancy and lactation, but they do need to recognize when they are unsure and know which reliable references to consult, because practice and evidence continue to change.