Heart health insights: Pregnancy

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According to the American Heart Association (AHA), cardiovascular disease remains the number one killer of women, claiming more lives than all forms of cancer combined. What’s more, a recent AHA survey also found that only 44% of women were aware of this fact, a significant decrease from 65% recorded in 2009. In other words, there’s an undeniable opportunity to better protect our hearts with education, resources and tools.

The sobering statistics, arguably, also contribute to the country’s consistent increase in maternal mortality.

“We are the only country in the western world that continues to witness a climb of maternal mortality rates — from 7 per 100,000 in the late 1980s to now more than 15 per 100,000,” says Valentyna Ivanova, MD, cardiologist at the Allegheny Health Network (AHN) Women’s Heart Center, and director of the AHN cardio-oncology program. “One of the primary causes of this increase has been the significant prevalence of cardiovascular disease among women.”

Maternal mortality rates have been even worse for Black and Hispanic women. Researchers trace the disparities to multiple social determinants affected by ongoing racism and discrimination, and Dr. Ivanova says there are parallel disparities in awareness.

“The declining statistics of cardiovascular disease awareness were seen mostly among Hispanic and Black women, and are most evident in women younger than 65 years old,” she explains. “When we pair that with the steadily climbing rates of maternal mortality across the country, we find that each and every February, American Heart Month, proves to be an essential moment to do our part to equip all women and their communities with the proper contacts, tools and resources to embrace their health.”

Heart health and pregnancy

Ronald Thomas

Dr. Ron Thomas, director of maternal-fetal medicine at Allegheny Health Network

There is good reason to pay closer attention to heart health during pregnancy, in particular.

“Pregnancy is the ultimate stress test for women — the heart is working harder than ever, sometimes revealing underlying issues or leading to conditions like heart attack or stroke,” says Dr. Ron Thomas, director of maternal-fetal medicine at AHN. “Labor and delivery add to the heart’s workload, and it can take weeks after delivery for the stress to return to post-pregnancy levels.”

As women move through early adulthood, increased estrogen production impacts the vascular system and blood flow. In pregnancy, the body increases blood production, with plasma volume increasing on average 45%, and sometimes more. The heart must pump more blood — and it also begins pumping faster. In some cases, heart rate can increase up to 20 beats per minute, and women may feel palpitations or develop arrhythmias.

As cardiac output increases, certain pregnant women may also be at risk for preeclampsia, a condition characterized by high blood pressure that can include signs of liver or kidney damage. Preeclampsia affects one in 25 pregnancies in the U.S., and pregnant women with preeclampsia are twice as likely to develop cardiovascular disease like heart attacks, strokes and heart failure, and four times as likely to develop high blood pressure later in life.

“The rate of preeclampsia mirrors other concerning national trends in the heart health field, as it also continues to increase year over year,” says Dr. Thomas. “Although this condition may resolve after delivery for most women, hypertension during pregnancy could put mom at risk for heart complications in the future. Hypertension can often be a ‘silent killer’ — women may not know they have it early on. Because they aren’t aware of its damaging effects, it has more time to do damage, and then we see more severe manifestations like congestive heart failure or renal disease.”

Risk factors

Valentyna Ivanova

Dr. Valentyna Ivanova, cardiologist at the AHN Women’s Heart Center, and director of the AHN cardio-oncology program

A number of factors impact heart health for pregnant women. Patients who already have diabetes or high blood pressure are at higher risk. Being overweight, getting pregnant later in life, or having a multiple gestation (twins, triplets, etc.) are also factors. That adds some context to the rising maternal mortality rates mentioned earlier.

“Women are waiting longer to get pregnant, so the general population of pregnant women in the U.S. is older than it used to be,” Dr. Thomas points out. “Unfortunately, things like vascular aging and diabetes both increase with age. More generally, we know that diabetes has become more prevalent, and the U.S. population is getting heavier. With or without advanced age, weight contributes to risk. Those categories — advanced age, increased weight, diabetes — put you at risk for having a pre-term birth, gestational hypertension, or preeclampsia.”

The good news is that there are some “highly modifiable risk factors” that women can control. For example, he explains, a significant percentage of factors that contribute to hypertension are controllable through diet, exercise, and general lifestyle.

The basic recommendations we all get from clinicians around overall health — weight control, regular exercise, proper nutrition, and stress management — are even more important for a woman who plans to get pregnant.

“Controlling your weight and maintaining a healthy lifestyle make you less likely to develop hypertension, preeclampsia, gestational diabetes, and other issues that can lead to a more complicated pregnancy,” he says.

Get the support you need

“At the end of the day, this all can paint a dire picture,” Dr. Ivanova says, noting that statistics like the rising maternal mortality rate, on top of the hormonal and physiological changes of being pregnant, can increase a woman’s anxiety. “Fear is understandable, but women are often more endurant than we give ourselves credit for, and it is important to focus on everything we can do to protect the health of the mother and child.”

Doctor Measuring Blood Pressure Of Her Pregnant Patient

Hypertension, or high blood pressure, is especially important to monitor during pregnancy and in the postpartum period.


Emily Laubham courtesy of Highmark Health Blog

To best support women through their pregnancies, AHN has closely aligned the AHN Women’s Heart Center with its OB/GYN program. Together, the patient’s clinical team offers a highly-specialized, coordinated care approach for high-risk scenarios that will best safeguard expectant mothers who may be experiencing heart-related issues even if they have no previous diagnosis.

Even in the simplest of pregnancies, concerns and questions may arise, and it’s best to get support and answers from your clinical team rather than enduring the extra stress of wondering whether something is wrong. When there are cardiovascular risks, it becomes even more important to maintain close communication with the experts throughout pregnancy and during the postpartum period.

“Listen to your body, and any questions you have, discuss with a specialist, including those of us at the Women’s Heart Center,” says Dr. Ivanova. “We can address anything that comes up. On an individual basis, we will guide you through it.”

Author: Emily Laubham