Five major complications of pregnancy are strong lifetime risk factors for ischemic heart disease, a new study found, with the greatest risk coming in the decade after childbirth.
Ischemic heart disease refers to heart problems, including a heart attack, caused by narrowed 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. Delivering early (before 37 weeks) or delivering a low birth weight baby was associated with a 72% and 10% increased risk, respectively.
The study, published Wednesday in the BMJ, followed a cohort of more than 2 million women in Sweden with no history of heart disease who gave birth to single live babies between 1973 and 2015.
Approximately 30% of women had at least one adverse pregnancy outcome. Those who had multiple adverse outcomes, either in the same pregnancy or in different pregnancies, were at increased risk of ischemic heart disease.
“These pregnancy outcomes are early signs of future heart disease risk and may help identify high-risk women earlier and allow earlier interventions to improve their long-term outcomes and help prevent the development of heart disease in these women. said Dr. Casey. Crump, study author and professor of family medicine at the Icahn School of Medicine at Mount Sinai.
Heart disease is the leading cause of death among women in the United States, accounting for 1 in 5 female deaths, according to the US Centers for Disease Control and Prevention.. This research adds to 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 of her future cardiovascular risk after pregnancy. And unfortunately, a lot of women aren’t told this,” said Dr. Tara Narula, CNN medical correspondent, associate professor of cardiology and the associate director of the Women’s Heart Program at Lenox Hill Hospital. She was not involved in the new study.
Although it’s not entirely clear why, experts say the normal changes that occur during pregnancy can unmask underlying health problems in some women with certain risk factors.
Experiencing an adverse pregnancy outcome, even temporarily, could lead to changes in the blood vessels and heart that may persist or progress after delivery, increasing a woman’s risk of cardiovascular disease.
This increased risk is a particular concern for women in the US, experts say, where the maternal mortality rate it is several times higher than in other high-income countries.
“There has been a change in the population that gives birth. American women become pregnant later in life and have already accumulated 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 at the US University School of Medicine, which was also not involved in the new study.
Complications of pregnancy are carefully monitored during pregnancy, but there is little evaluation and education about the effects on cardiovascular health after childbirth for women, experts say.
“So they have their delivery, maybe they had preeclampsia or gestational diabetes, and no one really follows up with them. They are not being told that they are, in fact, at higher risk,” Narula said.
Gestational diabetes is a marker not only for increased risk of diabetes, but also for cardiovascular disease in general. Preeclampsia 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 assessing patients and emphasizes the continued need for this.
“The classic risk calculator we use doesn’t include anything for pregnancy complications, but it should have for women, and hopefully one day they’ll start to take that into account,” she said.
He The American Heart Association recommends A detailed history of pregnancy complications is expected by all health professionals when assessing a woman’s risk of heart disease, but this is not done consistently in clinical practice, especially in primary care, where patients are cared for. most women, Crump says.
“Hopefully, increasing awareness of these findings among clinicians and women will allow more of these women to be tested early and hopefully improve their long-term outcomes,” she said.
Approximately 1 in 3 women will have an adverse pregnancy outcome. Experts say that improving your health before you get pregnant can help avoid these problems.
“Reducing your risk needs to start before conception, so getting yourself and your body to the healthiest possible state before you get pregnant is really the first step,” Narula said.
This includes 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 measures after pregnancy is equally important, since research has estimated that only 30% to 80% of women have a postpartum checkup 6 to 8 weeks after delivery.
“Making sure that these women actually get proper follow-up after delivery and that there is a warm transfer between [obstetrics] Y [maternal-fetal medicine] to their primary care physicians or preventive cardiologists who can then talk about optimizing cardiovascular risks and reducing these risk factors after pregnancy in the postpartum time period is crucial,” Sharma said.
Experts hope that increased awareness by patients and providers about the connection between pregnancy and heart health will prevent birth from being a cause of death.
“Cardiovascular disease can be prevented. It’s one of the leading causes 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,” Narula said. “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.”
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