You likely know the statistics: Heart disease is the leading cause of death for women and men, in the U.S. and worldwide. More than 400,000 women die each year from heart disease, and although death rates have been stable in the past 10 years, living with heart disease is physically, psychologically and financially burdensome for women and their families.
As researchers who work to identify risk factors for heart disease, we also know that mothers and pregnant women are particularly vulnerable to heart disease.
Most of the time, women carry and safely deliver a healthy newborn—but sometimes, expectant mothers develop complications, termed “adverse pregnancy outcomes,” that threaten their own lives and those of their unborn child—including hypertensive disorders of pregnancy, such as preeclampsia; gestational diabetes; pre-term delivery at 37 weeks; and births of babies in the less than 10 percent height and weight percentile.
These adverse pregnancy outcomes are common, complicating 10 to 20 percent of pregnancies. They’re also dangerous. According to a 2018 study from researchers at the University of Pittsburgh School of Medicine, women with a history of either preeclampsia or small-for-gestational age infant have a two-fold higher risk for heart disease and premature death, and women with the combination of both have up to an eight-fold higher risk of heart disease. And each year in the U.S., 50,000 women die during and immediately following pregnancy as the result of often common and treatable complications of pregnancy.
While many adverse pregnancy outcomes can be managed effectively during and immediately after pregnancy, others cannot. When they cannot, once hopeful families return home without their newborn or without their wives or partners. “The highs are so high,” a colleague who is a practicing obstetrician once commented on pregnancy, “but the lows are so low.”
Pregnancy is sometimes described as a “window to future cardiovascular health.” During patient interviews with women in my cardiology practice, women often report that the first time they were told they had high blood pressure was during pregnancy. One of my patients who is being treated for heart failure had a scary and complicated pregnancy that required her baby to be delivered early because she had dangerously high blood pressure. Many of my patients are not even aware that adverse pregnancy outcomes are the reason they are in my office.
Although the dangerous and deadly post-partum outcomes that take shape immediately warrant attention, the lifetime risks to a woman’s health are equally important. The strength of evidence linking adverse pregnancy outcomes with heart disease is so overwhelming that the leading guideline-making bodies in the field of cardiology, the American Heart Association and the American College of Cardiology, strongly advocate screening for adverse pregnancy outcomes in their recently updated guidelines.
One recommendation they make for clinicians is to ask women for a detailed history of their pregnancies, because doing so can identify women at increased risk of developing heart disease in the future. Experts also outline that pregnancy should be considered a natural “stress test” for women; according to these bodies, those who experience adverse pregnancy outcomes should receive the same enhanced risk status as a woman whose traditional “stress test” raises alerts.
Ideally, with more physicians asking questions about adverse pregnancy outcomes, more women will be empowered to ask the right questions about treatment options and get the treatment that they need. But making women aware of their risks for future heart disease is only effective if it leads to heart healthy behavior changes—including maintaining a healthy weight; eating a nutritious diet; sleeping seven to nine hours each night; and tracking cholesterol, blood pressure and blood glucose for diabetes (the primary risk factors for heart disease).
As mothers who each returned to work shortly after we had our children, both of us understand how difficult it is to prioritize our health when the needs of young children are so pressing. We understand that heart disease seems like a distant health risk when we are in our thirties and forties. We also know how frustrating, frightening and devastating it is to experience adverse pregnancy outcomes—and to know that our future heart health has become compromised.
For mothers, caring for our heart health is one more way we can show love for our children. For those who have lived through adverse pregnancy outcomes, mindfully addressing heart health can produce the best results for many years to come.
Mercedes Carnethon, Ph.D., is the Mary Harris Thompson Professor of Preventive Medicine and Chief of the Division of Epidemiology at the Northwestern University Feinberg School of Medicine and a Public Voices Fellow through The OpEd Project.
Sadiya Khan, MD MS, is an Assistant Professor of Medicine (Cardiology) and Preventive Medicine at the Northwestern University Feinberg School of Medicine.
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