Kenneth Shelton, MD, is a critical care physician and cardiothoracic anesthesiologist in the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital and the medical director of the Mass General Corrigan Minehan Heart Center Intensive Care Unit.
Nandita S. Scott, MD, co-director of the Corrigan Women’s Heart Health Program, talks about the relationship heart disease has with pregnancy.
Nandita S. Scott, MD, co-director of the Corrigan Women’s Heart Health Program, talks about the relationship heart disease has with pregnancy. Scott says while health conditions like cancer, stroke and diabetes deserve a great deal of attention, women need to be aware about heart issues, especially when giving thought to pregnancy.
Are pregnant women at a higher risk for getting heart disease compared to the general population?
Pregnancy is a unique time in a woman's life where her body is exposed to dramatic changes in the cardiovascular system that can be considered a type of stress test. For example, women who develop preeclampsia, a condition that occurs after the 20th week of pregnancy and causes high blood pressure and protein in the urine, have approximately double the risk of having a stroke, heart attack or blood clot over the next 5-15 years. Pregnancy provides a unique window into a young woman's life that provides information on her future cardiovascular risk.
Are there heart health concerns for woman who use birth control pills?
Yes, birth control pills can increase risk of blood clots, stroke, blood pressure and have certain effects on cholesterol, however this must be weighed against the risk of pregnancy, especially unwanted pregnancy.
What is the toll a pregnancy takes on a woman's body?
Huge ... What else can I say having had a twin pregnancy recently! Post partum it may take months for the cardiovascular system to return to normal. A woman is often left with excessive weight that also occurs at a time she is more likely to focus on taking care of everyone else around her and less on herself. It is very important at this time to work on heart healthy eating and exercise in an attempt to lose this weight. This will help reduce the risk of future cardiovascular issues but also make subsequent pregnancies more healthy.
What happens to the heart before, during and post pregnancy
During pregnancy the blood volume increases, blood pressure falls, cardiac output increases to 30-50% normal and these changes occur early. In addition, blood becomes "thicker" and the aorta and vessels become more complaint. These changes persist for months after delivery.
Does a pregnant woman's age influence the heart complications she can experience?
Yes, age likely contributes to increased risk of preeclampsia, pregnancy induced hypertension, gestational diabetes and risk for peripartum cardiomyopathy. Technically, advance maternal age is over 35. This is a spectrum so that your risk increases every year you get older. I think, however, that many women are having children at advanced maternal age and with good prenatal care, and most of these women will have healthy pregnancies.
Are there risk factors for premature heart disease in young women and how are they identified?
Yes. The usual important risk factors contribute such as high blood pressure, high cholesterol, diabetes as well as family history and smoking. There are certain conditions that are more common in women such as lupus and rheumatoid arthritis that cause systemic inflammation and increase risk for atherosclerosis
Is there hope for women who have heart conditions and want to get pregnant? Should they be concerned about their medications?
Women with pre-existing heart disease can absolutely get pregnant. There is only a small subset of patients when pregnancy is contraindicated. If a woman wants to get pregnant, she should seek counseling from her physician before she plans to do so, so that her medications can be weaned off or changed to less teratogenic forms (i.e., less harmful to the growing fetus). When continuing a medication, the risk/benefit of medication vs. underlying treatment of heart disease must be weighed.
For more information about heart health and women, visit the Corrigan Women’s Heart Health Program.
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