Pregnancy: A Matter of the Heart
By Dr. Jennifer Haythe
As a cardiologist who specializes in the care of women with heart disease, I am repeatedly confronted with one overwhelming truth — women do not know that cardiovascular disease is their #1 risk of death. The reasons for this are likely multi-factorial and include: misrepresentation of heart disease in literature, television and movies as a man’s disease, bias in the medical field, and under-representation of women in cardiovascular research studies.
It is therefore not surprising that cardiovascular disease is one of the major contributors to the high rates of maternal morbidity and mortality in the United States and in many countries across the world. The changes to the cardiovascular system during pregnancy are significant and myriad: heart rate increases, blood pressure actually trends lower, blood volume increase dramatically, cardiac output increases. In many ways pregnancy is like a stress test for the heart.
I specialize in in heart disease in pregnancy (cardio-obstetrics) and take care of pregnant women with heart attacks, heart arrhythmias, valvular heart disease, heart failure syndromes, blood clots and pulmonary embolism, and hypertensive disorders of pregnancy. In fact, pre-eclampsia (a disorder of blood pressure) and pre-term labor are now identified as risk factors for women developing heart disease later in life.
A 2018 study published in the Mayo Clinic Proceedings demonstrated that the risk of having a heart attack while pregnant, giving birth and in the 2 months post-partum rose 25% between 2002 and 2014. In addition, approximately 4.5% of these women died in the hospital from complications of a heart attack — a surprisingly high number.
The most likely explanation for the increasing rates of heart disease and complications in pregnancy is an increase in the presence of cardiac risk factors in pregnant women including obesity, sedentary lifestyle, hypertension, diabetes, and high cholesterol. Advancing maternal age makes these risk factors more likely to be present.
It is crucial that women and their care providers know just how critical heart health is for a safe pregnancy and to be especially vigilant of risk factor diagnosis and management. Women also need to feel comfortable expressing their symptoms and concerns to their providers and should expect appropriate reactions and work-up. Women’s symptoms need to be taken seriously and evaluated accordingly in order to minimize risk and ensure the safest possible outcomes for mother and child.
Dr. Jennifer Haythe graduated from Harvard in 1995 and completed her medical school, residency and fellowship training at Columbia University. She is an Assistant Professor of Medicine in the Columbia Center for Advanced Cardiac Care, Director of the Cardiac-Obstetric program and Co-Director of the Columbia Women’s Heart Center. She lives in New York City with her husband and two children and is an avid runner. She can be found on Twitter at @drjennhaythe.