Heart issues during pregnancy could set the stage for future stroke, heart attack risk
As American Heart Month gets underway, experts are warning that heart issues during pregnancy could set the stage for future risks from stroke and heart attack.
Cardiovascular disease during pregnancy is the leading cause of pregnancy-related death in the United States, according to the American College of Obstetricians and Gynecologists (ACOG).
It also raises a woman's lifetime risk of future cardiovascular problems, including stroke, heart attack and high blood pressure by 60% or more depending on the type of pregnancy complication, according to a recent analysis by the American Heart Association (AHA).
"Pregnancy is like a stress test on the heart," Dr. Jennifer Haythe, a cardiologist and director of the cardio-obstetric program at Columbia University Irving Medical Center, told ABC News. "Women who have either known or unknown, undiagnosed cardiovascular disease may become much more symptomatic during pregnancy and in the peripartum."
During pregnancy, the heart and blood vessels adjust their structure and ability to pump as they prepare to handle more blood and the demands of a growing baby, according to the American College of Obstetricians and Gynecologists (ACOG).
Pregnant women can also develop gestational hypertension, pre-eclampsia and gestational diabetes, Haythe explained. Additionally, pregnant women may have a greater risk of developing heart failure from cardiomyopathy, a condition that makes it more difficult for the heart muscles to pump efficiently, which can be diagnosed before or during pregnancy.
Over the past 30 years, pregnancy-related deaths have risen by 140%, according to the AHA. One reason for the increase may be women having babies later in life.
During the same period, the average age of a woman having her first baby rose from about 21 years to about 27.5 years, according to the National Center for Family & Marriage Research.
"Women are having children much later, and so they are an increased risk for heart disease because they tend to have more risk factors," Haythe noted. "Because they're older, they may have underlying hypertension, diabetes, high cholesterol, obesity, a sedentary lifestyle."
In fact, women older than 40 years old have 30 times greater risk of heart disease-related maternal death risk than women younger than 20 years old, according to ACOG.
Metabolic stress and vascular changes of pregnancy associated with pregnancy and birth complications are linked to an increased risk of heart failure, heart attacks and strokes later in life, although it's unclear exactly why, according to the analysis.
Women with hypertensive disorders of pregnancy have a two-to-four-fold higher risk of developing chronic hypertension 10 or more years later compared to women with normal blood pressure in pregnancy.
"If you had any pregnancy outcomes like preeclampsia, like hypertensive disorders of pregnancy, like gestational diabetes, you should be evaluated for your cardiovascular risk assessment ... and you should be followed for cardiovascular risk assessment every year," Dr. Anais Hausvater, a cardiologist and co-director of the cardio-obstetrics research program at NYU Langone Health, told ABC News.
Hausvater added that even young women should focus on their heart health before, during and after pregnancy.
"We know that the earlier you start to optimize your heart health, the lower your risk," she explained. "And pregnancy and postpartum can be a really ideal time where women are hooked in with their with the medical system to kind of establish and start to make those changes."
There is some good news related to pregnancy and heart health, the experts said. The Centers for Disease Control and Prevention found that about 80% of pregnancy-related deaths, including those for heart-related issues, are preventable.
Early prenatal care as well as early, regular visits with a doctor during pregnancy -- and timely follow up in the weeks, months and years after pregnancy -- can improve those odds.
"Your gynecologic and obstetric history is an integral part of your medical history," Haythe said. "It should not be overlooked or forgotten when you see your doctor."
Mia G. Antinone, MD, is a family medicine resident physician at OhioHealth Riverside Methodist Hospital and a member of the ABC News Medical Unit.
