Fewer than 5% of pregnant women have good heart health, according to study. Experts say doctors need to do more in response.

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CHICAGO — Cardiovascular disease is the leading cause of death during pregnancy and the postpartum period, and U.S. health experts are working to better understand why so many moms are dying.

But many women might be unaware of their heart risks while pregnant — and the importance of taking steps to improve heart health is becoming clearer in light of a new study.

On Monday, Northwestern Medicine researchers published what they say is the first study to examine the cardiovascular health of pregnant women in the United States.

Using 15 years of data from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey, the Journal of the American Heart Association article analyzed records of 1,117 pregnant and 8,200 nonpregnant women, assessing key factors including diet, exercise and blood pressure.

Among pregnant women, the study found 4.6% had high cardiovascular health, 61% had moderate cardiovascular health and 35% had low cardiovascular health. Younger women and African Americans were most affected.

Such figures mean doctors need to do more to assess the heart health of pregnant patients, said James Martin, chair of The American College of Obstetricians and Gynecologists’ Pregnancy and Heart Disease Task Force.

“We must think of heart disease as a possibility in every pregnant or postpartum patient we see, to detect and treat at-risk mothers,” Martin said in a statement.

Black women are particularly at risk while pregnant; in Illinois, they were six times more likely to die from pregnancy-related conditions, according to a 2018 review of cases. The American College of Obstetricians and Gynecologists, while recommending in 2019 that all women be assessed for heart disease while pregnant, noted black women’s risk of dying from cardiovascular disease was 3.4 times higher than that of white women, a disparity it attributed in part to racial bias and racism in the health care system.

During pregnancy, the heart works harder and pumps more blood, which can reveal underlying heart issues or lead to conditions like a heart attack, chest pain or stroke. Some patients already know they have issues like congenital heart disease, but many others develop problems while pregnant.

“Sometimes women don’t know they have heart disease, and because of these changes in pregnancy, lo and behold, they start having problems,” said Marla Mendelson, medical director of Northwestern Medicine’s Heart Disease and Pregnancy Program at the Bluhm Cardiovascular Institute, which includes maternal-fetal medicine, anesthesia and obstetrics specialists.

It’s not only an important time for the baby’s health, but also for the mother’s health after birth, said Amanda Marma Perak, preventive cardiologist at Lurie Children’s Hospital.

“A lot of women don’t know, and far too many women neglect their heart health,” Perak said.

In Illinois, 22% of 140 maternal deaths studied from 2002 to 2011 were related to cardiovascular disease, according to a 2019 article in the American Heart Association’s journal “Circulation: Cardiovascular Quality and Outcomes.” The state’s 2018 maternal mortality review included several examples of women with cardiac conditions.

Despite these risks, heart issues among women are still not fully understood. In part, this is because of a lack of research; it can be difficult to study pregnancy, which includes many changes in the body. But, Perak said, it is not impossible.

“Obviously it is a really important time,” Perak said. “I think we’re improving in our knowledge of it, but we still have a long way to go.”

Cardiologists are only now beginning to realize their role in assessing heart health during pregnancy, said Nandita Scott, a cardiologist and co-director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital.

Cardiologists do not get extensive training regarding pregnancy — Scott said she didn’t receive much — and only recently has the field of cardio-obstetrics emerged.

The American Heart Association recommends creating more cardio-obstetrics teams, which could include experts from cardiology, obstetrics, maternal-fetal medicine, anesthesia and nursing. In 2018, the American Heart Association and the American College of Obstetricians and Gynecologists released a joint advisory stressing the need for medical providers to team up to better identify heart risks.

In Kansas City, Saint Luke’s Hospital is beginning a Heart Outcomes in Pregnancy Expectations, or HOPE Registry, which will collect and study data to better understand maternal heart disease.

A number of factors impact heart health among pregnant women. Patients with diabetes or high blood pressure can be at higher risk; other factors include being overweight, getting pregnant later in life or having a multiple gestation pregnancy.

The risk does not end after childbirth. Women can be vulnerable for weeks, and even months, after giving birth. Patients with hypertension during pregnancy, for example, should continue to have their blood pressure monitored, Mendelson said.

The six weeks following childbirth is a high-risk time for complications, but many women don’t see their doctor during that time. The American College of Obstetricians and Gynecologists has recommended earlier follow-up visits, and health experts also say home visits by a nurse after birth can make it easier to spot and assess issues for both mom and baby. For patients with hypertensive disorders or heart disease, a follow-up with a provider within 14 days is recommended.

“Also, realize that you need to advocate for yourself,” Scott said of mothers, noting that even tennis star Serena Williams said she had to alert doctors when something felt off, ultimately revealing blood clots in her lungs after her daughter was born in 2017.

Women can reduce their risk for heart issues by entering pregnancy, when possible, in their best physical shape. Plan a heart-healthy diet: lots of fruits and vegetables, lean proteins like fish and low-fat dairy. Limit processed foods like soda and packaged snacks, which have a lot of sugar and salt. Talk to your doctor about exercise, which is often safe and beneficial. Even a brisk walk for 20 or 30 minutes can get your heart rate up.

And know the symptoms of heart issues.

“The things that we really watch out for: difficulty breathing when lying down; any type of chest pain should be evaluated; rapid heart rate,” Mendelson said. “These are signs that there may be a problem.”


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