Pregnancy complications increase heart disease risk, study finds

Five major pregnancy complications are strong lifetime risk factors for ischemic heart disease, a new study finds, with the highest risk occurring in the decade after delivery.

Ischemic heart disease refers to heart problems, including heart attack, caused by narrow or dysfunctional blood vessels that reduce the flow of blood and oxygen 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.

Giving birth to a baby before 37 weeks – or giving birth to a low birth weight baby were associated with a 72% and 10% increased risk, respectively.

The study, published in the academic journal BMJ, followed more than 2 million women in Sweden with no history of heart disease who gave birth to live babies between 1973 and 2015.

About 30% of women have had at least one adverse pregnancy outcome.

Those who had multiple adverse outcomes – whether in the same or different pregnancies – were at increased risk of ischemic heart disease.

“These pregnancy results are early signs of future heart disease risk and may help identify high-risk women earlier and allow for early interventions to improve their long-term outcomes and help prevent the development of heart disease in these women,” he said. The Doctor. Casey Crump, study author and professor of family medicine at the Icahn School of Medicine at Mount Sinai.

Cardiovascular disease and pregnancy

Heart disease is the leading cause of death among 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 the 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 for her future cardiovascular risk after pregnancy. And, unfortunately, many women do not hear this from anyone, “said the medical correspondent of the CNN , Dr. Tara Narula, associate professor of cardiology and associate director of the Women’s Heart Program at Lenox Hill Hospital.

While it’s not completely clear why, experts say the normal changes that occur during pregnancy can reveal underlying health issues in some women with certain risk factors.

Experiencing an adverse pregnancy outcome – even temporarily – can result in changes in the blood vessels and heart that can persist or progress after delivery, increasing a woman’s risk of cardiovascular disease.

That heightened risk is of particular concern for women in the US, experts say, where the maternal death rate is several times higher than in other high-income countries. “There has been a shift in the population of births.

American women are getting pregnant later in life and have already accumulated perhaps one or two cardiovascular risk factors.

Maybe there are other stressors in life — depression, stress, isolation, obesity — lots of different things that are affecting women in the US,” said Dr. Garima Sharma, associate professor of cardiology and director of the Cardio-Obstetrics Program at Johns Hopkins. University School of Medicine, which was also not involved in the new study.

Pregnancy complications are carefully monitored during pregnancy, but there is little evaluation and education about cardiovascular health effects after childbirth for women, experts say.

“And then they deliver, maybe they have pre-eclampsia or gestational diabetes, and nobody really follows up with them. They are not informed that they are, in fact, at greater risk,” Narula said.

Gestational diabetes is a marker not only for increased risk of diabetes, but also for cardiovascular disease in general. Pre-eclampsia and eclampsia are risk markers for hypertension as well as general cardiovascular risks.

Narula, a cardiologist who specializes in caring for women, regularly considers adverse pregnancy outcomes when evaluating patients and emphasizes the continued need for this.

“The classic risk calculator we use doesn’t contain anything for pregnancy complications, but, you know, it should for women, and hopefully someday they’ll start taking that into account,” she said.

The American Heart Association recommends that all health care professionals take a detailed history of pregnancy complications when assessing a woman’s risk of heart disease, but this is not done consistently in clinical practice, especially in primary care, where most of women is taken care of, says Crump.

“Raising awareness of these findings among clinicians and women will allow more of these women to be screened early and hopefully improve their long-term outcomes,” he said.

How to lower the risk

About 1 in 3 women will have an adverse pregnancy outcome.

Experts say improving your health before you get pregnant can help you avoid these problems. “Reducing risk should start with preconception, and so getting your body and yourself into the healthiest state possible before you even get pregnant is really the first step,” Narula said.

These include achieving and maintaining a healthy body weight with a good diet and regular exercise, managing high blood pressure and diabetes, quitting smoking, and managing stress.

Taking action after pregnancy is equally important, as research estimates that only 30% to 80% of women have a postpartum checkup 6 to 8 weeks after giving birth.

“Making sure that these women are really followed up properly after giving birth and that there is a warm transfer between [obstetrícia] and [medicina materno-fetal] for your primary care physicians or preventive cardiologists who can talk about optimizing cardiovascular risks and reducing these post-pregnancy risk factors in the postpartum period is crucial,” Sharma said.

Experts hope that increasing patient and provider awareness of the connection between pregnancy and heart health will prevent birth from being the cause of death.

“Cardiovascular disease is preventable. It’s a leading cause of maternal mortality, but it doesn’t have to be. If we do a better job of screening patients before they become pregnant, if we do a better job of treating them during pregnancy and postpartum, we can improve outcomes for women,” said Narula.

“It’s a tragedy to bring a new life into the world, and then the mother suffers some horrible complication and/or death that could have been prevented.”