During her fellowship in cardiology at Johns Hopkins, Anum Minhas was struck by a glaring gap in clinical knowledge and care.
“I noticed that there was very little evidence about how best to manage women who are pregnant with heart disease,” she recalls. “Pregnancy is one of the single most common experiences women will have. It was baffling to me why we lagged so far behind in knowing how to care for these patients and in researching how cardiac complications during pregnancy might impact women’s future heart health.”
Noting that “it felt like a place where there were a lot of questions to be answered,” Minhas set out to break new ground as a clinician-researcher. With the encouragement of her fellowship director Steve Schulman and Obstetrics and Maternal Fetal Medicine Directors Andrew Satin and Jeanne Sheffield, she launched a Cardio-Obstetrics Clinic at Johns Hopkins together with Jason Vaught, a maternal fetal medicine specialist.
The multidisciplinary clinic, one of just a handful across the country, follows women with heart disease throughout their pregnancy, as well as those who develop cardiac conditions in the midst of their pregnancy, such as preeclampsia. Characterized by sudden high blood pressure, preeclampsia — which occurs in roughly 1 in 25 pregnancies — can lead to organ damage and maternal/fetal death if not properly treated.
“From the very first day, high-risk OB patients sit down with both Jason and me and together we develop a plan and answer their questions,” says Minhas, who was recently named a CIM Next Generation Scholar. “Then we see patients with the most complicated conditions once a month.”
“What’s particularly unique about our clinic is that both Jason and I also practice as critical care intensivists, so we are very comfortable handling patients with high acuity,” says Minhas. “Some of our patients even deliver in the Cardiac Critical Care Unit with an ECMO unit [a form of advanced, temporary life support] at the ready.”
Minhas and Vaught also conduct pre-conception counseling visits for women with genetic disorders that puts them at risk for heart conditions such as cardiomyopathy. “They might not have the disease yet but we counsel them on the risks. Sometimes we make the hard call that it might be too risky for a woman to be pregnant and we suggest they consider other ways to expand their family,” says Minhas. “We have learned that patients will decide what is in line with their values and we support them in that. We say, ‘If you do decide to pursue pregnancy, we will be happy to be your physicians.’”
“The field of cardiology research neglected women for a long time, and certainly pregnant women have traditionally not been included in research, so it’s time to expand the horizons of what we know.” – Anum Minhas
While providing these patients with the highest level of care, Minhas is also pursuing research that will help fill in existing gaps and allow for more individualized care for pregnant women with cardiac conditions. Her efforts on both fronts have received a big boost with her CIM Next Generation Scholar award.
The Next Generation Scholars program was created to support outstanding early-career faculty who are innovators in the areas of research, education and clinical care, and whose work will fortify medicine as a public trust. Each CIM Next Generation Scholar is eligible to receive up to $300,000 of funding over three years.
Minhas says the support will enable her to tap into advances in data science, informatics and machine learning in her pursuit of new treatments and preventative therapies for patients and their babies.
She has begun work on building a biobank, which will contain samples of blood and urine of pregnant patients treated at Johns Hopkins who are at risk of cardiac disease. The ultimate goal, she explains, is to develop biomarkers for different conditions that would allow clinicians to spot risks earlier on.
Minhas also plans “to dig deeper” by leveraging electronic health record data that exists for the more than 2.6 million patients in the Johns Hopkins Health System to investigate questions such as: If you experience heart complications during pregnancy, what does it mean for future heart health?
The answers she finds could inform precision medicine approaches to cardiac care during pregnancy. With preeclampsia, for example, she notes that some women who develop the condition have known risk factors, such as high blood pressure, diabetes or kidney disease. But others seem perfectly healthy. “We can’t just manage preeclampsia as a blanket condition,” she says. Through machine learning, she aims to identify different phenotypes — perhaps a maternal signature for some patients, a placental signature for others — that could inform more targeted treatments.
Minhas is also working to broaden clinical expertise in cardio-obstetrics. She created the first fellowship curriculum in the specialty area, which was published in 2021, and has mentored three fellows in the Cardio-Obstetrics pathway since she joined the Johns Hopkins faculty.
She sees considerable room for continued growth for Cardio-Obstetrics in research, education and patient care. “The field of cardiology research neglected women for a long time, and certainly pregnant women have traditionally not been included in research,” says Minhas, “so it’s time to expand the horizons of what we know.”
