Five major pregnancy complications are lifelong risk factors for ischemic heart disease, a new study finds, with the greatest risk in the decade after delivery.
Ischemic heart disease refers to heart problems, including heart attacks, caused by narrowed or dysfunctional blood vessels that reduce the flow of blood and oxygen to the heart.
Gestational diabetes and preeclampsia increased the risk of ischemic heart disease by 54% and 30%, respectively, in the study, while other hypertensive disorders during pregnancy doubled the risk. Giving birth early – before 37 weeks – or having a low birth weight baby was associated with a 72% and 10% increased risk, respectively.
The study, published Wednesday in the BMJ, followed a cohort of more than two million Swedish women without a history of heart disease who gave birth to a single live baby between 1973 and 2015.
About 30% of women had at least one adverse pregnancy outcome. Those who had multiple adverse outcomes—whether in the same or different pregnancies—were shown to have an increased risk of ischemic heart disease.
“These pregnancy outcomes are early indicators of future heart disease risk and may help identify high-risk women earlier and improve their long-term outcomes and help prevent the development of heart disease in these women,” Dr. Casey said. Crump, the study’s author, is a professor of family medicine at Mount Sinai’s Icahn School of Medicine.
According to the US Centers for Disease Control and Prevention, heart disease is the leading cause of death in women in the United States, killing 1 in 5 women. This research adds to the mounting evidence that pregnancy provides important information about a woman’s heart health.
“What happens to a woman during pregnancy is almost like a stress test or a marker for her future heart risk after pregnancy. And unfortunately, many women don’t tell anyone,” CNN medical correspondent Dr. said Tara Narula, an associate professor of cardiology and. Associate Director of the Women’s Heart Program at Lennox Hill Hospital. She was not involved in the new study.
Although it’s not entirely clear why, experts say the normal changes that occur during pregnancy can offset underlying health problems in some women with certain risk factors.
Experiencing adverse pregnancy outcomes can cause changes—even temporary—in blood vessels and the heart that may persist or progress after delivery, putting a woman at increased risk of heart disease.
This increased risk is of particular concern for women in the U.S., experts say, where maternal mortality rates are many times higher than in other high-income countries.
“There has been a shift in the birth population. U.S. women are getting pregnant at a later age, and they’ve already accumulated one or two cardiovascular risk factors. “There are probably other stressors in life — depression, stress, loneliness, obesity — many different things that are affecting women in America,” said Dr. Garima Sharma, associate professor of cardiology and director of the Cardio-Obstetrics Program at Johns Hopkins University School of Medicine, which also were not involved in the new study.
Pregnancy complications are carefully monitored during pregnancy, but there is little assessment and education about the effects on heart health after delivery for women, experts say.
“And so they’re delivered, they might have preeclampsia or gestational diabetes, and no one’s following up with them. They’re not being told, actually they’re at higher risk,” Narula said.
Gestational diabetes is a marker not only for increased risk of diabetes but also for general cardiovascular disease. Preeclampsia and eclampsia are markers for high blood pressure risk as well as general heart attack risk.
Narula, a cardiologist who specializes in women’s care, routinely considers adverse pregnancy outcomes when assessing patients and emphasizes the ongoing need for this.
“The classic risk calculator that we use doesn’t have anything for pregnancy complications, but you know, it should be for women, and hopefully one day, they’ll start taking that into account,” she said.
The American Heart Association recommends that all health care professionals take a detailed history of pregnancy complications when assessing a woman’s heart disease risk, but this is not consistently done in clinical practice, especially in primary care, where most women are seen, Crump says.
“Increasing awareness of these findings among physicians and women will hopefully enable early screening of these women and improve their long-term outcomes,” he said.
About 1 in 3 women will have an adverse pregnancy outcome. Experts say that improving your health before getting pregnant can help you avoid these problems.
“Reducing your risk should start pre-conception, and so getting your body and yourself in a healthy state before you get pregnant is really the first step,” Narula said.
These include achieving and maintaining a healthy body weight with a good diet and regular exercise, controlling high blood pressure and diabetes, quitting smoking and managing stress.
Taking steps after pregnancy is equally important, as research estimates that 30% to 80% of women only have a postpartum checkup 6 to 8 weeks after delivery.
“Making sure these women are actually followed up properly after their birth and there’s a warm handoff in between [obstetrics] and [maternal-fetal medicine] Their primary care doctors or preventive cardiologists who can then talk about post-pregnancy optimization to optimize heart attack risk and reduce these risk factors in the postpartum time frame,” Sharma said.
Experts hope that increasing patient and provider awareness of the link between pregnancy and heart health will prevent births from becoming a cause of death.
“Heart disease is preventable. It’s a leading cause of maternal death, but it doesn’t have to be. If we do a better job of screening patients before pregnancy, if we do a better job of treating them during pregnancy and delivery, we can improve women’s outcomes.” ,” Narula said. “It’s a tragedy to bring a new life into the world, and then the mother could have prevented some horrible complications and/or death.”