A study reveals that complications during pregnancy are associated with a higher risk of heart disease

CNN
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The five major complications of pregnancy are strong lifelong risk factors for ischemic heart disease, new study findings, with the highest risk in the decade after delivery.

Ischemic heart disease refers to heart problems, including heart attacks, 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. Having a baby early – before 37 weeks – or having a baby with a low birth weight is 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 one live child 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 or different pregnancies – showed an additional increased risk of ischemic heart disease.

“These pregnancy outcomes are early signals for future heart disease risk and can help identify high-risk women earlier and allow earlier interventions to improve their long-term outcomes and help prevent these women from developing heart disease,” 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 and is responsible for 1 in 5 female deaths, according to the US Centers for Disease Control and Prevention. This research adds accumulation of 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 for her future cardiovascular risk after pregnancy. Unfortunately, for many women, no one tells them this,” said CNN medical correspondent Dr. Tara Narula, an associate professor of cardiology and assistant 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 reveal underlying health problems in some women with certain risk factors.

An unfavorable pregnancy outcome – even temporarily – can result in changes to the blood vessels and heart that may persist or progress after delivery, increasing a woman’s risk of cardiovascular disease.

This increased risk is of particular concern to women in the US, experts say, where maternal mortality rate is several times higher than in other high-income countries.

“There has been a change in the birth population. Women in the US are becoming pregnant at a later age and may already have one or two cardiovascular risk factors. “There may be other causes of stress in life—depression, stress, isolation, obesity—a lot of different things that affect women in the US,” said Dr. Garima Sharma, associate professor of cardiology and director of the Cardio-Obstetrics Program at Johns Hopkins. of the University’s Faculty of Medicine, which was also not involved in the new study.

Pregnancy complications are closely monitored during pregnancy, but there is little evaluation and education about the effects on cardiovascular health after delivery, experts say.

“And so they give birth, maybe they had preeclampsia or gestational diabetes, and no one really follows them. They were not told that, in fact, they are exposed to increased risk,” said Narula.

Gestational diabetes is a marker not only for increased risk of diabetes, but also for general cardiovascular disease. Preeclampsia and eclampsia are indicators of hypertension risk, as well as general cardiovascular risks.

Narula, a cardiologist who specializes in women’s care, regularly considers adverse pregnancy outcomes when evaluating patients and emphasizes the ongoing need for this.

“The classic risk calculator that we use doesn’t have anything for pregnancy complications, but you know, it should for women, and hopefully one day they’ll start to take that into account,” she said.

The The American Heart Association recommends that all health care providers take a detailed history of pregnancy complications when assessing a woman’s heart disease risk, but this is not done consistently in clinical practice, particularly in primary care, where most women are seen, Crump says.

“Raising awareness of these findings among doctors, as well as among women, will hopefully allow more of these women to be screened early and hopefully improve their long-term outcomes,” he said.

Rough 1 in 3 women will have an unfavorable pregnancy outcome. Experts say that improving your health before pregnancy can help avoid these problems.

“Reducing your risk should be the first step, so getting your body and yourself in the healthiest possible state before you even get pregnant is really the first step,” Narula said.

These include achieving and maintaining a healthy weight with good nutrition and regular exercise, controlling high blood pressure and diabetes, quitting smoking and managing stress.

Taking action after pregnancy is just as important as Research estimated that only 30% to 80% of women have a postpartum examination 6 to 8 weeks after delivery.

“Making sure that these women are really followed up properly after giving birth and that there is a warm handover between them [obstetrics] and [maternal-fetal medicine] to their primary care physicians or preventive cardiologists who can then discuss optimizing cardiovascular risks and reducing these risk factors after pregnancy in the postpartum time frame is critical,” Sharma said.

Experts hope that increased awareness among patients and providers about the connection between pregnancy and heart health will prevent childbirth from being the cause of death.

“Cardiovascular diseases can be prevented. It is the leading cause of maternal mortality, but it doesn’t have to be. If we do a better job of screening patients before they get pregnant, if we do a better job of treating them during pregnancy and after delivery, we can improve outcomes for women,” Narula said. “It is 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.”