presentation

AI/AN women experience some of the highest rates of pregnancy-related deaths in the United States. Research has shown that cardiovascular conditions contribute to these deaths, but much of this information comes from general maternal mortality data rather than AI/AN-specific findings.

This is a problem because AI/AN data are often missing or grouped with other racial and ethnic populations, making it difficult to identify which specific cardiovascular conditions are contributing to these deaths and where prevention efforts are needed.

Because of this, I wanted to take a closer look at the existing research to understand what data is currently present on the cardiovascular conditions that are contributing to maternal mortality among AI/AN women, and whether studies are reporting these specific findings for AI/AN women or mainly focusing on general maternal mortality statistics.

To answer these questions, I conducted a systematic review of existing research, starting with two searches in PubMed focused on maternal mortality and cardiovascular health among American Indian and Alaska Native women.

I focused on studies published within the past 10 years that were written in English and involved human participants. I also went through reference lists to see if there were any additional studies we might have missed.

When deciding which studies to include, I looked for research involving AI/AN women between the ages of 10 and 60 in the United States or its territories that reported information on maternal mortality and cardiovascular conditions. I considered all study designs as long as they met our eligibility criteria

Once we had our search results, another reviewer and I used a program called Covidence to independently screen the titles, abstracts, and full texts to determine which studies were relevant to our review.

For the studies that were included, I then extracted information on pregnancy-related deaths and cardiovascular conditions, covered by ICD-10 codes O10 through O16.

And to show how we narrowed down our initial search results to the final studies included in the review, I created this PRISMA flow diagram, which you can see here.

The initial searches identified 152 records, and after screening, we ended up including 54 studies in the review. But out of those 54 studies, only 17, or about 31.5%, actually reported AI/AN-specific cardiovascular findings.This was one of the biggest findings of my review because it shows just how limited the available data are

As you can see in Table 1, many studies included or mentioned AI/AN women, but didn't actually report their cardiovascular findings separately from other populations. And this lack of specific data is especially concerning when we look at how high pregnancy-related mortality rates are among AI/AN women. For example, a 2025 study found that AI/AN women experienced about 106 pregnancy-related deaths per 100,000 live births, which was 3.8 times the rate among White women.

Looking at Figure 2, we can see some of the specific cardiovascular conditions contributing to these deaths. Between 2007 and 2016, cardiomyopathy, which is a disease affecting the heart muscle, accounted for 14.5% of AI/AN pregnancy-related deaths. This was followed by hypertensive disorders, or high blood pressure conditions, at 12.8%, other cardiovascular conditions at 11.1%, and cerebrovascular accidents, or strokes, at 5.8%.

So this figure gives us an example of the kind of AI/AN-specific information we're looking for, but as my review found, not many studies actually report these causes of death separately for AI/AN women

So overall, my review found that while many studies report the high rates of pregnancy-related deaths among AI/AN women, far fewer provide specific information about the cardiovascular conditions contributing to these deaths.

One of the biggest issues is how this information is reported. Studies often group AI/AN women with other racial and ethnic populations, making it difficult to identify findings specific to AI/AN women. Others discuss cardiovascular conditions, like heart disease and high blood pressure, but don't clearly show how these conditions contribute to pregnancy-related deaths

This matters because without knowing which specific conditions are contributing to these deaths, it's harder to identify where prevention efforts are needed, such as improving screening for high blood pressure during pregnancy or providing earlier treatment for heart conditions.

Ultimately, my review highlights the need for more research that reports AI/AN-specific cardiovascular causes of death, along with culturally grounded maternal healthcare that better meets the needs of AI/AN women. 

Moving forward, I want to share these findings with Indigenous researchers, healthcare providers, and community members to get their feedback on how this information can be used to improve maternal healthcare. I'm especially interested in how traditional Indigenous birthing practices can be better included to help improve outcomes.

I also want to make sure this research gives back to the communities it focuses on. One way I hope to do this is by sharing my findings with organizations like Hummingbird Indigenous Family Services and other Indigenous birth worker groups to see how this research could support better maternal healthcare.

Hi, I'm Isabella! It's nice to meet you. This is my research poster! Would you like me to walk you through it, or do you have any specific questions you'd like me to answer?

That's a really great question! I don't know the answer off the top of my head, but I'd love to look into it and follow up with you. Is there a good email I could reach you at?