Complications during pregnancy linked to a higher risk of heart disease, study finds
February 3, 2023
Complications during pregnancy linked to a higher risk of heart disease, study finds,ATLANTA (AP) — A new study finds that five major pregnancy complications are strong lifelong risk factors for ischemic heart disease, with the greatest risk occurring in the decade following delivery.
Ischemic heart disease refers to heart problems, such as heart attacks, that are caused by narrowed or dysfunctional blood vessels, which reduce blood and oxygen flow to the heart.
In the study, gestational diabetes and preeclampsia increased the risk of ischemic heart disease by 54% and 30%, respectively, while other high blood pressure disorders doubled the risk. Delivering a baby before 37 weeks or with a low birth weight was associated with a 72% and 10% increase in risk, respectively.
The study, published in the British Medical Journal on Wednesday, followed a group of over 2 million Swedish women with no history of heart disease who gave birth to single live infants between 1973 and 2015.
Approximately 30% of the women had at least one negative pregnancy outcome. Those who had multiple negative pregnancy outcomes, whether in the same or different pregnancies, had a higher risk of ischemic heart disease.
“These pregnancy outcomes are early signals for future risk of heart disease and can help identify high-risk women earlier and enable earlier interventions to improve their long-term outcomes and help prevent the development of heart disease in these women,” said Dr. Casey Crump, one of the study’s authors and a professor of family medicine at Mount Sinai.
Cardiovascular disease and pregnancy
According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death among women in the United States, accounting for one in every five female deaths. This study adds to the growing body of evidence that pregnancy provides critical information about a woman’s cardiovascular health.
“What a woman experiences during pregnancy is almost like a stress test or a predictor of her future cardiovascular risk after pregnancy. Unfortunately, many women are not told this by anyone “Dr. Tara Narula, an associate professor of cardiology and the associate director of the Women’s Heart Program at Lenox Hill Hospital, told CNN Medical Correspondent Tara Narula. She was not a participant in the new study.
Although it is unclear why, experts believe that the normal changes that occur during pregnancy may reveal underlying health issues in some women who have certain risk factors.
An unfavorable pregnancy outcome, even if only temporarily, can cause changes in blood vessels and the heart that can last or progress after delivery, increasing a woman’s risk of cardiovascular disease.
According to experts, this increased risk is especially concerning for women in the United States, where maternal mortality is several times higher than in other high-income countries.
“There has been a shift in the birth rate. Women in the United States are becoming pregnant later in life, and they may already have one or two cardiovascular risk factors. Perhaps there are other stressors in life — depression, stress, isolation, obesity — a variety of factors affecting women in the United States “Dr. Garima Sharma, associate professor of cardiology and director of the Cardio-Obstetrics Program at Johns Hopkins University School of Medicine, who was not involved in the new research, agreed.
Experts say that while pregnancy complications are closely monitored, there is little evaluation and education about the effects on women’s cardiovascular health after delivery.
“And so they have their delivery, they’ve had maybe preeclampsia or gestational diabetes, and nobody really follows up with them. They are not told that, in fact, they are at increased risk,” Narula said.
Gestational diabetes is a risk factor not only for diabetes but also for general cardiovascular disease. Preeclampsia and eclampsia are risk factors for hypertension and other cardiovascular diseases.
Narula, a cardiologist who specializes in women’s care, regularly considers adverse pregnancy outcomes when evaluating patients and emphasizes the importance of doing so in the future.
“The classic risk calculator that we use doesn’t have anything in it for pregnancy complications, but you know, it should for women, and hopefully someday they will start to take that into account,” she explained.
According to Crump, 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. However, this is not always done in clinical practice, particularly in primary care, where the majority of women are seen.
“Increasing awareness of these findings among physicians and women will hopefully allow more of these women to be screened early and hopefully improve their long-term outcomes,” he said.
How to decrease your risk
One in every three women will have a negative pregnancy outcome. According to experts, improving your health before getting pregnant can help you avoid these problems.
“Reducing your risk should start before you even get pregnant,” Narula says.
This includes achieving and maintaining a healthy body weight through a healthy diet and regular exercise, managing high blood pressure and diabetes, quitting smoking, and dealing with stress.
Taking action after pregnancy is equally important, as research indicates that only 30% to 80% of women have a six to eight week postpartum checkup.
“It is critical to ensure that these women are appropriately followed after delivery and that there is a warm handoff from (obstetrics) and (maternal-fetal medicine) to their primary care doctors or preventive cardiologists who can then talk about optimizing cardiovascular risks and reducing these risk factors post-pregnancy in the postpartum time frame,” Sharma said.
Experts hope that increased patient and provider understanding of the link between pregnancy and heart health will prevent birth from being a cause of death.
“Cardiovascular disease can be avoided. It’s a leading cause of maternal death, but it doesn’t have to be that way. We can improve women’s outcomes if we do a better job of screening patients before they become pregnant and treating them during pregnancy and postpartum “Narula stated. “It’s a tragedy to bring a new life into the world, only to have the mother suffer from some horrifying complication and/or death that could have been avoided.”