Sarah Goldstein, MD, FACC

Sarah Goldstein, MD, is a cardiologist who takes care of adults with congenital heart disease and pregnant patients with congenital or acquired heart disease.

The daughter of two physicians, Dr. Goldstein says she learned from an early age “what being a doctor would be like, and I always loved science,” she says.

In medical school, Dr. Goldstein was drawn to cardiology because of its complex physiology. “I also enjoyed the interactions with patients with heart disease and how cardiologists can have a big impact on their patient’s quality of life,” she says. “When I decided to focus on adult congenital heart disease, I spent time in my mentor’s clinic where she also cared for pregnant patients affected by cardiac conditions. Pregnancy is such an important time in a patient’s life, but having heart disease adds a layer of stress that can greatly impact their pregnancy experience.”

Dr. Goldstein went on to complete specialized training in cardio-obstetrics, an area of medicine that is growing in popularity and need. “At Yale, our maternal cardiac team cares for patients with heart disease before, during and immediately following pregnancy. This multidisciplinary team includes cardiologists, maternal-fetal medicine specialists, obstetric anesthesiologists, and many others,” she says.

Heart disease is the leading cause of maternal mortality in the United States, Dr. Goldstein points out.

“Over the last 30 years, the U.S. is the only developed country in the world in which maternal mortality has been worsening. Historically, complications related to pregnancy itself such as preeclampsia and hemorrhage were the most common causes of maternal death,” she says. “Over time, however, cardiovascular disease has emerged as the leading cause of death related to pregnancy and now accounts for around 30% of all maternal mortality. This shift is likely caused by a number of factors, including increased rates of both acquired and congenital heart disease affecting patients of childbearing age.”

When she meets a new pregnant patient with heart disease, Dr. Goldstein says she first makes sure her patient understands their cardiac diagnosis and how it may affect their pregnancy experience.

“I want to know what their goals and expectations of their pregnancy are as well as their comfort level with certain risks, interventions and medications that may be needed to manage their heart disease during pregnancy,” she says. “Each management plan is patient specific. Many pregnant patients with heart disease may have previously been told they should never get pregnant, which is a heavy burden to carry. I explain that I am trained to take care of them and keep them as healthy as possible during pregnancy which typically provides reassurance.”

Dr. Goldstein’s research focuses on improving the effectiveness of preconception counseling, as well as the management during and after pregnancy, for patients with complex cardiac disease.