Kalgi Modi, MD
Kalgi Modi, MD, FACC, is an Associate Professor and Director of the Interventional Cardiology Program at LSU Health Shreveport School of Medicine.
Pregnancy and new motherhood present so much stress that heart health may not seem like an immediate priority. However, medical research is increasingly suggesting that certain complications during pregnancy may be a signal of heart disease and problems may be evident during pregnancy or even later.
The United States has a higher pregnancy-related death rate than other developed countries with 1 in 2,400 women at lifetime risk. The largest proportion of pregnancy-related deaths, about one in five, is attributed to heart disease. Considering the fact that women who are having babies are usually young and in good health, heart disease shouldn't be the leading cause of pregnancy-related deaths. We need to pay much more attention to preventing, recognizing and treating heart disease in pregnant women so that these deaths can be prevented.
High blood pressure, diabetes, high cholesterol, smoking, preterm birth or baby’s slow growth during pregnancy may indicate a higher risk of heart disease in the future. A majority of heart-related deaths are from cardiomyopathy, a condition in which the heart muscle is weakened. This can lead to heart failure, irregular heartbeats, and death.
Women who are most likely to have a heart failure from pregnancy are African-American, hypertensive, obese and with multiple pregnancies. Pregnancy also increases the risk of a fatal heart attack even in apparently healthy women who do not have the traditional risk factors for heart disease.
Heart attacks affect about one in every 16,000 deliveries. It can occur mostly in the last three months of pregnancy or first few weeks after delivery. In fact, standard heart attack therapies can make a pregnant woman's heart attack even worse.
Normally, the most common cause of a heart attack is a narrowing of the arteries from deposits of fatty plaques. Instead, nearly half of the heart attacks in pregnancy are caused by a condition called coronary dissection, when the inner and outer layers of an artery around the heart peel apart from each other blocking the blood flow to heart muscle. Treating pregnant women with heart attack is a big challenge for cardiologists. Giving these women a clot-busting drug or stents, which normally help other patients, can actually make the artery tear even further.
The take-home message is that any pregnant woman who has risk factors or who is complaining of chest tightness, shortness of breath, heart palpitations, tiredness, or swelling, needs to be evaluated as if she were otherwise not pregnant. Being aware now of the potential link between pregnancy and heart disease can help one take steps for a healthy future of mother and baby. I encourage women to talk with their obstetrician and primary care physician about their risk factors and symptoms for heart disease and whether she could benefit from a referral to a cardiologist and/or lifestyle and medication changes.
By Kalgi Modi, MD, FACC. Dr. Modi is an Associate Professor and Director of the Interventional Cardiology Program at LSU Health Shreveport School of Medicine.