COLUMBUS, Ohio – Pregnancy-related deaths in the U.S. have risen 140% over the past three decades with heart disease a major cause, according to the American Heart Association. A new national survey commissioned by The Ohio State University Wexner Medical Center found that many Americans are not aware of the long-term risks of heart disease with pregnancy and the critical care needed before, during and after pregnancy.
"During pregnancy there are a lot of different hormone shifts that happen to accommodate growth of the baby and health of the mom. The result is that the mom's heart rate increases along with the amount of fluid in the body. This can put stress on the heart as does the physical strain of labor and delivery," said Lauren Hassen, MD , a cardiologist and clinical assistant professor in the The Ohio State University College of Medicine 's Division of Cardiovascular Medicine .
Hassen said it is important for patients to talk with their doctor about pre-existing health issues before getting pregnant and any health changes during or after pregnancy.
"There are conditions that develop during pregnancy that we call adverse pregnancy outcomes like gestational hypertension, preeclampsia, gestational diabetes and pre-term delivery. All of these conditions increase the long-term risk for heart disease," Hassen said.
Unfortunately, many Americans are unaware of these risks. Ohio State's survey of 1,008 Americans found that most believe symptoms like fatigue (73%) and nausea (65%) are normal during and after pregnancy while half wouldn't consider fluid retention or upper back or neck pain as a medical concern. However, these conditions could be signs of heart problems like hypertension (high blood pressure), cardiomyopathy (when the heart doesn't pump properly) or preeclampsia, which is a pregnancy-related disorder that causes a spike in blood pressure.
"Preeclampsia has been linked to an elevated risk of heart disease and stroke. These patients can develop heart disease 10 years earlier than their peers so we know we need to be watching for it, which is why postpartum care for this disorder and others is so important," Hassen said.
Getting the best care with a cardio-obstetrics team
For Laura Lima de Souza, 38, of Reynoldsburg, she relied on Ohio State's cardio-obstetrics team for her care since she has vascular Ehlers-Danlos Syndrome, a connective tissue disease that can cause severe complications during pregnancy. A cardio-obstetrics team is often comprised of obstetricians, cardiologists, anesthesiologists, maternal fetal medicine specialists, geneticists, nurses and pharmacists who work together to develop a comprehensive approach for managing heart disease before, during and after pregnancy.
Ohio State's cardio-obstetrics team was concerned about Lima de Souza's uterus rupturing or blood clots developing as well as her advanced maternal age. They closely monitored her to determine the best date for her Caesarean delivery and ensured her entire heart and obstetrics team was available if needed. Her aftercare took place in Ohio State's Richard M. Ross Heart Hospital while her daughter was cared for in the newborn nursery.
"I managed my risk during pregnancy in a few ways. I had a robust medical team of an OB/GYN, high-risk pregnancy doctor, cardiovascular surgeon, cardiologist and counselor that I've been seeing for 13 years," Lima de Souza said. "The other piece was stress management because with pregnancy you have an increase of blood volume, and the stress on your arteries, aorta and heart increases. I did a lot of stress management through journaling, mindfulness and meditation and making sure I moved my body and ate the right foods."
Ohio State recently started the Cardiology Postpartum Transition Clinic to address the cardiovascular needs of patients who are postpartum, often referred to by cardiologists as the "fourth trimester."
"I see patients starting a few weeks after delivery and often several months later to address ongoing cardiovascular issues that arose during pregnancy or assess their long-term risk of cardiovascular disease related to adverse pregnancy outcomes," Hassen said.
Hassen is working with an Ohio State team studying different approaches to postpartum blood pressure control as part of a $12.5 million three-state study .
Today, Lima de Souza has two healthy children and continues to keep a close eye on her health, including regular checkups and a full-body MRI every two years to check her vascular system.
"When it comes to your health, if something doesn't feel right, have it checked out. Ask questions and remember that you're not alone. It's the unknown where you don't want to be," she said.
Survey methodology
