The growing death rate in pregnant and post-partum women is caused in part by pre-existing conditions such as high blood pressure and diabetes, the Heart Association said in a statement. Another problem is the increasing rate of pregnancies among older women which can be “associated with pre-term birth, preeclampsia and chronic hypertension.”
“During the first trimester of a normal pregnancy, the heart rate increases and blood pressure decreases. In the second and third trimesters, the heart rate and blood pressure increase and don’t decrease until after birth. For those with certain cardiovascular diseases, these up-and-down swings can be dangerous.”
“Just being pregnant alone is a natural stress test, just like you go to a cardiologist and you run on a treadmill. It’s called a stress test,” Afshar said.
“Pregnancy does that naturally. There’s a lot of cardiovascular changes, structurally, hemodynamically, meaning flow, the pipes and the pumps change to sustain your growing another human being to sustain that high volume load,” Afshar added.
“And, you know, appreciating these physiologic changes that are all completely normal in the context of cardiovascular diseases is just beginning to surface.”
Cardio-obstetrics teams for high risk pregnancies
A team of specialists can better manage pregnant women at high risk of complications from heart conditions, the Heart Association said. These so-called cardio-obstetrics teams or pregnancy health teams include obstetricians, cardiologists, maternal fetal medicine specialists, nurses, and anesthesiologist, among others.
“These pregnancy heart teams comprehensively manage cardiovascular disease during pregnancy and ultimately help reduce pregnancy-related deaths,” Mehta said.
Although these cardio-obstetrics are becoming more common, not everyone needs a cardiologist and maternal fetal medicine specialist during pregnancy.
“But those that have underlying congenital heart disease, those that have hypertension, those that have some of the risk factors we’ve addressed, need a team of people with different expertise coming together with the same goal,” Afshar said.
The goal is a healthy pregnancy, a healthy baby and, in the longer term, a healthy mother.
Long term risks of cardiac conditions during pregnancy
“A lot of women are unaware that having any of these issues during pregnancy puts them at a higher risk of developing heart disease in the future, and it may surface years down the road,” Mehta said. “That’s why it’s so important for women with pregnancy-related heart disease to continue to see a cardiologist regularly after they’ve delivered their baby,” she said
Other common high blood pressure conditions during pregnancy include gestational hypertension and chronic hypertension or a combination of chronic hypertension and preeclampsia, the AHA said. Cardiovascular disease can also include other medical conditions such as ischemic heart disease, arrhythmias, aortic disease, deep venous thrombosis, pulmonary embolism and valvular heart disease.
“Involvement of the cardio-obstetrics team from preconception to postpartum care is critical because these experts working together can help identify ways to prevent maternal morbidity and mortality,” Mehta said.