Recently, researchers have discovered that certain pregnancy and birth complications affect the heart health of the mother, putting her at an increased risk of cardiovascular disease over her lifetime. To find out more about the findings, we turned to cardiologist Dr. Lidija McGrath, M.D., co-director of the Maternal Cardiac Program at OHSU.
Several studies revealed that pregnancy-related conditions such as gestational hypertension, pre-eclampsia, eclampsia, HELPP syndrome, and others resulted in an elevated cardiovascular risk for the mother. Additionally, certain fetal outcomes, such as fetal growth restriction or preterm birth, have demonstrated a similar increased risk. Studies suggest these conditions – which occur in approximately 20% of pregnancies - can represent up to a 2-3-fold increase in risk.
For example, if a healthy 24-year-old with no other risk factors experiences severe pre-eclampsia during pregnancy, she would have a nearly 3-fold increase in risk of developing heart disease in her lifetime. It is important to note that this data revealed the increased risk even after adjusting for other factors such as obesity or smoking.
Currently, the most commonly used tools for assessing an individual’s cardiovascular risk do not include pregnancy outcomes. Historically, studies of lifetime risk have focused on men. But newer studies, many out of Europe, include pregnancy data from as far back as the 1970’s. These studies provide applicable data across the lifespan, and have helped expand the field of cardio-obstetrics.
“This is an area of very active research,” says Dr. McGrath, “A lot of things are coming out now that are really eye-opening for us to think about.”
Because this research is still new, Dr. McGrath urges women who have experienced any of these conditions during pregnancy or birth to advocate for themselves during medical visits.
“It’s important women bring up their obstetric history with their health care team, starting with their primary care provider,” says Dr. McGrath, “Not everybody is going to ask about their obstetric history, and oftentimes the history will focus on the baby.”
“It’s important to take that extra step to say, ‘Actually, it was complicated a bit by X, Y, Z. How does that affect my health?’” she adds.
The good news is that identifying the increased risk allows doctors and patients to focus on preventive care. This includes lifestyle and behavioral changes for better heart health. Dr. McGrath stresses the importance of regular exercise, a balanced diet and maintaining a healthy weight. Other important steps include ensuring blood pressure is well-controlled and doing an age-appropriate lipid screening.
She also advises mothers who have experienced pregnancy complications to consult with their provider before having another child. There are often treatments available to lower the risk of developing the same complications in another pregnancy. For example, a simple intervention such as low-dose aspirin is now recommended in appropriately selected patients to reduce the risk of developing pre-eclampsia in a second or later pregnancy. Dr. McGrath encourages patients to connect with their provider about options, and to consult with a cardiologist when indicated.