Another American Heart Month has come to a close. For the past four weeks the we’ve been bombarded with everything from commercials and news stories to diet tips and red dresses. So what have we learned - specially women?
There are the usual grim statistics: Heart disease is the number one killer of women; heart disease remains the number one cause of death in the US for both men and women; heart disease, in all its forms, is responsible for over 400,000 deaths a year among women – more than all forms of cancer combined. And although new research on the importance of heart-healthy diets, exercise and quitting smoking have decreased heart disease rates among men in the past 30 years, the rate for women hasn’t budged. We’ve all heard or read about the signs and symptoms of heart disease in women and the risk factors. Yet there is one huge area of female heart health not found at the forefront of public education: pregnancy and heart disease.
“Over the last ten years we’ve seen more and more women with congenital heart disease survive to grow into their reproductive years,” said Nazanin Moghbeli, MD, MPH, FACC, the director of the Women’s Cardiovascular Center at Pennsylvania Hospital. “Some women with repaired congenital heart disease can have a safe pregnancy with little risk. However, the normal physiological changes that occur during pregnancy, particularly those during the second and third trimesters, can worsen symptoms of congestive heart failure and arrhythmias and cause problems to develop - even in women exhibiting no symptoms before pregnancy. And no two patient situations are alike. A woman with heart disease should see a cardiologist for a full evaluation and risk assessment prior to conception, and a tailored course of treatment personalized to address her particular needs throughout her pregnancy.”
Dr. Nazaqnin Moghbeli, director of the Women’s Cardiovascular Center at Pennsylvania Hospital
According to the American Heart Association, consulting with a cardiologist specializing in adult congenital heart disease and pregnant women allows time for a physician to treat any problems that could arise during your pregnancy. There are even some types of heart disease considered so high risk that pregnancy isn't recommended, Armed with complete medical histories, modern diagnostic tests, procedures and medications, physicians can now better assess and effectively manage the treatment of women with existing heart disease prior to pregnancy. As many women are waiting longer to become pregnant, the spectrum of cardiovascular disease among pregnant women is changing as well. “There are ways to optimize outcomes for pregnant women with structural heart disease, as well as ways to minimize the risks of complications that can arise during pregnancy,” said Dr. Moghbeli who regularly teams up with Penn Medicine obstetricians to treat pregnant women with heart disease “Together we have thie outstanding opportunity to educate women as to their cardiac risk and help them both before, during and after pregnancy.
Where to start?
Women with a pre-existing heart condition should take special precautions under the supervised guidance of a physician before and during pregnancy as these conditions may increase a woman’s risk for complications during pregnancy. For some women their heart or vascular conditions aren’t identified until they are pregnant.
Women should also know and understand the changes that occur to the heart and blood vessels during pregnancy since they add stress to a woman’s body and cause the heart to work harder. They include increased blood volume, cardiac output and heart rate and usually, decreased blood pressure.
During the first trimester, blood volume increases 40 to 50 percent and remains higher throughout the pregnancy. It is normal for a woman’s average heart rate to increase during pregnancy by ten to 15 beats per minute.
During the nine months of pregnancy, women can also develop preeclampsia, the onset of high blood pressure and excess protein in the urine after 20 weeks of pregnancy. Preeclampsia must be caught and treated swiftly. A leading cause of preterm births, there is no known prevention against preeclampsia. It also increases a woman’s risk of heart disease after pregnancy.
Gestational diabetes and gestational hypertension - or gestational high blood pressure - also place women at a significantly increased risk of heart disease, even after delivery.
Want to learn more? Click here to listen to an interview with Dr. Moghbeli discussing ways to minimize risks and optimize outcomes for pregnant women with heart disease.