Cardiovascular disease is a major concern for women during pregnancy
Pregnancy is becoming more dangerous for women in the United States. Mortality rates are increasing across the country and cardiovascular disease remains the single largest cause of indirect maternal mortality, accounting for more than 30% of all pregnancy-related maternal deaths.
The following questions were recently answered by two physician leads within Allegheny Health Network’s Cardio-Obstetrics Clinic — Indu Poornima, M.D., cardiologist, and Devon Ramaeker, M.D., maternal fetal medicine specialist — as part of a speaker series hosted by AHN.
Q: What changes take place in the cardiovascular system when someone is pregnant?
A: A person’s cardiac output, defined as the amount of blood pumped out by the heart every minute, increases significantly during pregnancy, especially during labor and immediately postpartum. The heart is working harder to supply the pregnancy and placenta additional blood and nutrients, and the actual volume of blood you have in your body notably increases during pregnancy.
These changes can occur as early as five to six weeks into pregnancy, and may not return to a prepregnancy state for months up to one year following delivery.
Q: What are some early signs and symptoms of heart-related complications inpregnancy? When should birthing people speak with theirphysician?
A: Cardiovascular disease in pregnancy can be challenging to identify, as many symptoms can also be regular occurrences in a pregnant state. Heart palpitations, chest pain, shortness of breath, dizziness or pain/swelling in the lower legs can all be related to an underlying heart issue or blood clotting condition.
Many of them, however, can be completely benign and a result of normal anatomical changes that take place. For example, the significant increase in blood volume during pregnancy can change the structure of the heart, causing heart palpitations.
Q: When should I be concerned?
A: The severity of the symptom is usually a top indicator, if a patient is presenting with a more complex cardiovascular issue. Severe chest pain at rest or with minimal baseline activity is not normal for pregnancy but can be seen when a patient overexerts themselves. However, for any symptom that is causing an obstetric patient concern, we strongly encourage them to speak with their respective OB/GYN, cardiologist or maternal fetalmedicine physician.
Q: Can you go into more detail about gestational hypertension and preeclampsia?
A: Gestational hypertension is high blood pressure without protein in the urine or other organ damage during pregnancy. Roughly 10–25% of women with gestational hypertension can progress to preeclampsia, which involves high blood pressure, protein in urine and symptoms like severe headaches, vision changes and abdominal pain. If a birthing person is diagnosed with preeclampsia, it is often a precursor for hypertension, or cardiovascular disease, in the future. The rates of preeclampsia in the United States continue to rise year over year, contributing to higher maternal mortality rates.
Q: What does the management of preeclampsia look like?
A: The diagnosis of preeclampsia may require blood pressure reading, blood tests, urine screen and ultrasounds to look at baby’s growth. For mild cases of preeclampsia, providers will recommend increase of prenatal appointments for blood pressure monitoring, ongoing blood test evaluation and ultrasounds to check on baby’s wellbeing.
For more severe cases, hospitalization, or delivery isrecommended; physicians may also prescribe blood pressuremedications.
Following delivery, patients should continue to monitor blood pressure and other cardiovascular risk factors in consultation with their cardiologist.
Q: What can someone do to best prepare for pregnancy and improve
cardiovascular health?
A: Intention to improve your health profile is really the most important factor — if a birthing person feels empowered to make important lifestyle changes, that’s the bestlaunching point.
Our recommendation would be to consult with your physician on what the best next steps may be — whether that’s adjustments to nutrition, exercise or medications.
Q: What should someone with a preexisting heart condition do if they are trying to conceive?
A: We strongly encourage any birthing person with a preexisting heart condition to seek specialty care, whether that’s from a cardiologist or maternal fetal medicine physician. Some health systems, like Allegheny Health Network, offer specialized Cardio-Obstetrics clinics that bring together multidisciplinary teams to help ensure mother and baby have positive health outcomes prior to, during and followingpregnancy.