Michael M. Aziz, MD, MPH: Complications in Maternal Fetal Medicine

Michael M. Aziz, MD, MPH, is a maternal-fetal medicine (MFM) specialist and attending physician at Allegheny Health Network (AHN). In this interview, he explained that recent breaking news of a published study has provided level 1 evidence that tighter blood pressure control in patients throughout pregnancy leads to better outcomes as well as lower diagnosis of superimposed preeclampsia.

Prenatal care was invented at the turn of last century, according to Aziz. He continued to elaborate on the common complications seen in patients along with fetal anomalies he encounters during treatment.

"Before we had blood pressure cuffs, there was no preeclampsia," Aziz explained, "there was only eclampsia. So, that's why we started doing that. It was to monitor patients blood pressure over the course of the pregnancy and to screen for preeclampsia and other hypertensive disorders of pregnancy."

In the US, pregnant patients are screened for a multitude of conditions, and almost all for gestational diabetes, in an effort to identify health problems early in pregnancy to better manage them, if possible. However, Aziz spoke about the high maternal mortality rate in the country.

"We don't just have a high maternal mortality rate," he said, "we have the highest of any developed country in the world. And even worse than that, our maternal mortality rate has been rising over the past decade or so."

The causes of maternal mortality are not only due to patients getting older, because Aziz made it clear that you can be older and have a "wonderful, happy and healthy pregnancy." However, it's a surrogate marker for having other health issues.

One of those issues was brought on with the obesity epidemic. Because of the association between obesity and cesarean delivery, those rates are higher. Additionally, rates of venous thromboembolism are increased.

"And then, before our COVID 19 pandemic, we were in the middle of an opioid epidemic, which also is a major source of death in young people, as well as a mental health epidemic," Aziz explained. "And then, you take a very highly combustible situation and then pour the COVID-19 pandemic on top of it."

"And that's why we've seen an even higher rate of maternal mortality," he said, "And I think, it's a national embarrassment."