Heart disease drives spike in pregnancy-related deaths, American Heart Association says
The growing death rate in pregnant and post-partum women is caused in part by pre-existing conditions such as high blood pressure and diabetes, the Heart Association said in a statement. Another problem is the increasing rate of pregnancies among older women which can be "associated with pre-term birth, preeclampsia and chronic hypertension."
"Being pregnant can put a lot of stress on the body, especially the heart," said Dr. Laxmi Mehta, a cardiologist at The Ohio State University who led the team that wrote the statement.
"During the first trimester of a normal pregnancy, the heart rate increases and blood pressure decreases. In the second and third trimesters, the heart rate and blood pressure increase and don't decrease until after birth. For those with certain cardiovascular diseases, these up-and-down swings can be dangerous."
Health experts are just beginning to see maternal cardiac disease and heart disease as a major threat not only to women's long-term cardiovascular health, but to safe motherhood, said Dr. Yalda Afshar, an assistant professor in the Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology at UCLA Health.
"Just being pregnant alone is a natural stress test, just like you go to a cardiologist and you run on a treadmill. It's called a stress test," Afshar said.
"Pregnancy does that naturally. There's a lot of cardiovascular changes, structurally, hemodynamically, meaning flow, the pipes and the pumps change to sustain your growing another human being to sustain that high volume load," Afshar added.
"And, you know, appreciating these physiologic changes that are all completely normal in the context of cardiovascular diseases is just beginning to surface."
Cardio-obstetrics teams for high risk pregnancies
The AHA recommends women with cardiovascular disease or at high risk of developing it during pregnancy work with cardio-obstetrics teams before and during pregnancy and after delivery.
A team of specialists can better manage pregnant women at high risk of complications from heart conditions, the Heart Association said. These so-called cardio-obstetrics teams or pregnancy health teams include obstetricians, cardiologists, maternal fetal medicine specialists, nurses, and anesthesiologist, among others.
"These pregnancy heart teams comprehensively manage cardiovascular disease during pregnancy and ultimately help reduce pregnancy-related deaths," Mehta said.
Although these cardio-obstetrics are becoming more common, not everyone needs a cardiologist and maternal fetal medicine specialist during pregnancy.
"But those that have underlying congenital heart disease, those that have hypertension, those that have some of the risk factors we've addressed, need a team of people with different expertise coming together with the same goal," Afshar said.
The goal is a healthy pregnancy, a healthy baby and, in the longer term, a healthy mother.
Long term risks of cardiac conditions during pregnancy
The AHA statement also said it's "essential" for women with pre-existing cardiac conditions or a history of preeclampsia, one of the most common heart conditions characterized by high blood pressure after 20 weeks of pregnancy, to get preconception counseling. Women who develop preeclampsia are at much greater risk of dying during pregnancy and at much higher risk of coronary artery disease and heart failure during their lifetimes.
"A lot of women are unaware that having any of these issues during pregnancy puts them at a higher risk of developing heart disease in the future, and it may surface years down the road," Mehta said. "That's why it's so important for women with pregnancy-related heart disease to continue to see a cardiologist regularly after they've delivered their baby," she said
Other common high blood pressure conditions during pregnancy include gestational hypertension and chronic hypertension or a combination of chronic hypertension and preeclampsia, the AHA said. Cardiovascular disease can also include other medical conditions such as ischemic heart disease, arrhythmias, aortic disease, deep venous thrombosis, pulmonary embolism and valvular heart disease.
Pregnancy-related deaths in the United States have jumped from 7.2 deaths per 100,000 live births in 1987 to almost 17 deaths per 100,000 live births in 2017, according to the US Centers for Disease Control and Prevention. African American women are at a substantially higher risk for pre-existing heart conditions, as well.
The authors of the AHA statement are urging cardiovascular and primary care physicians to develop a general understanding of cardiovascular disease during pregnancy.
"Involvement of the cardio-obstetrics team from preconception to postpartum care is critical because these experts working together can help identify ways to prevent maternal morbidity and mortality," Mehta said.
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