According to a new study, five major pregnancy complications are powerful risk factors for ischemic heart disease throughout life, with the greatest risk occurring within a decade of giving birth.
Ischemic heart disease refers to heart problems, including heart attack, caused by narrowed or dysfunctional blood vessels that reduce blood and oxygen flow to the heart.
Gestational diabetes and preeclampsia increased the risk of ischemic heart disease in the study by 54% and 30%, respectively, while other high blood pressure disorders during pregnancy doubled the risk. Early delivery – before 37 weeks – or delivering a baby with a low birth weight were associated with an increased risk of 72% and 10%, respectively.
The study, published in the BMJ on Wednesday, followed a cohort of more than 2 million women in Sweden with no history of heart disease who gave birth to live unmarried children 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 pregnancy or in different pregnancies – showed an even increased risk of ischemic heart disease.
“These pregnancy outcomes are early signals of future risk for heart disease and may help identify high-risk women earlier and enable earlier interventions to improve their long-term outcomes and help prevent disease development. heart disease in these women,” said Dr. Casey. Crump, study author and professor of family medicine at the Icahn School of Medicine at Mount Sinai.
Heart disease is the leading cause of death for women in the United States and accounts for 1 in 5 female deaths, according to the US Centers for Disease Control and Prevention. This research adds to growing evidence that pregnancy provides important information about a woman’s cardiovascular health.
“What happens to a woman during pregnancy is almost like a stress test or a marker of her future cardiovascular risk after pregnancy. And unfortunately, no one tells a lot of women that,” the CNN medical correspondent said. , Dr. Tara Narula, Associate Professor of Cardiology and associate director of the Women’s Heart Program at Lenox Hill Hospital. She did not participate in the new study.
Although the reason isn’t completely clear, experts say the normal changes that occur during pregnancy may reveal underlying health issues in some women with certain risk factors.
An adverse pregnancy outcome, even temporary, can lead to changes in the blood vessels and heart that may persist or progress after delivery, increasing a woman’s risk of cardiovascular disease.
This increased risk is particularly concerning for women in the United States, experts say, where the maternal mortality rate is several times higher than in other high-income countries.
“There has been a change in the population of births. American women become pregnant at a later age and they have already accumulated perhaps one or two cardiovascular risk factors. There may be other stressors in life – depression, stress, isolation, obesity – many different things that affect women in the United States,” said Dr. Garima Sharma, associate professor of cardiology and director of the cardio-obstetrics program at Johns Hopkins. University School of Medicine, which also did not participate in the new study.
Pregnancy complications are carefully monitored during pregnancy, but there is little assessment and education about postpartum cardiovascular health effects for women, experts say.
“And so they have their delivery, they may have had preeclampsia or gestational diabetes, and no one is really following them. They are not told that in fact they are at increased risk,” Narula said.
Gestational diabetes is a marker not only of an increased risk of diabetes, but also of general cardiovascular disease. Preeclampsia and eclampsia are markers of hypertension risk as well as general cardiovascular risks.
Narula, a cardiologist specializing in women’s care, regularly considers adverse pregnancy outcomes when evaluating patients and stresses the continued need for this.
“The classic risk calculator we use doesn’t have anything for pregnancy complications, but you know, it should for women, and hopefully one day they’ll start taking it into account,” he said. she declared.
The American Heart Association recommends that all healthcare professionals take a detailed history of pregnancy complications when assessing a woman’s risk of heart disease, but this is not routinely done in clinical practice. especially in primary care, where most women are seen, Crump says.
“Awareness of these findings with doctors as well as women will hopefully allow more of these women to be screened early and hopefully improve their long-term outcomes,” he said. declared.
About 1 in 3 women will have an adverse pregnancy outcome. Experts say improving your health before you get pregnant can help avoid these problems.
“Reducing your risk should start before you conceive, and so getting your body and yourself into the healthiest state possible before you even get pregnant is really the first step,” Narula said.
This includes achieving and maintaining a healthy body weight with proper diet and regular exercise, controlling high blood pressure and diabetes, quitting smoking, and managing stress.
It is equally important to take action after pregnancy, as research has estimated that only 30-80% of women have a postpartum exam 6-8 weeks after giving birth.
“Ensure that these women are indeed followed appropriately after their delivery and that there is a warm transfer between [obstetrics] and [maternal-fetal medicine] to their primary care physicians or preventive cardiologists who can then talk about optimizing cardiovascular risks and reducing those risk factors after pregnancy in the postpartum period is crucial,” Sharma said.
Experts hope that increasing patient and provider awareness of the link between pregnancy and heart health will prevent birth from being a cause of death.
“Cardiovascular disease is preventable. It is one of the main causes of maternal death, but it does not have to be. If we are better at screening patients before they become pregnant, if we are better at treating them during pregnancy and postpartum, we can improve outcomes for women,” Narula said. “It’s a tragedy to bring a new life into the world and then the mother suffers a horrific complication and/or a death that could have been prevented.”