How Pregnancy Can Be a Predictor of Heart Disease

Carrying extra weight, having high blood pressure and being sedentary are well-known risk factors for heart disease. But here’s another major risk factor that may surprise many women: pregnancy complications, even long after you got rid of your maternity clothes.

Heather Johnson, M.D., a preventive cardiologist with the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital.

“We are trying to spread the word that, yes, your pregnancy history is important even if it was decades ago,” says Heather Johnson, M.D., a preventive cardiologist with the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital, part of Baptist Health. “Your pregnancy can tell us if you are at higher risk for heart disease, stroke or even heart failure.”

In particular, six pregnancy-related complications — high blood pressure, gestational diabetes, preterm delivery, small-for-gestational-age delivery, pregnancy loss or placental abruption — significantly increase a woman’s risk for developing cardiovascular disease later in life, according to a scientific statement from the American Heart Association, published in the flagship journal Circulation.

The statement calls for vigorous efforts to prevent cardiovascular disease among women who experience these complications as they transition from pregnancy and postpartum care back to primary care, with continued follow-up to monitor their risk throughout their lives.

“Any woman is at risk if she had pregnancy complications. Years later, women may not connect the dots because no one emphasized to them that they need to continue to be monitored,” says Paula Montana De La Cadena, M.D., a cardiologist at Miami Cardiac & Vascular Institute, also part of Baptist Health. “Even if things get better after the pregnancy, you need to keep an eye on your health and get regular check ups.”

Paula Montana De La Cadena, M.D., a cardiologist at Miami Cardiac & Vascular Institute.

Between 10 percent and 15 percent of women experience adverse pregnancy outcomes, according to the American Heart Association. Statistics on their additional risk are startling:

• High blood pressure in pregnancy, called gestational hypertension, increases a woman’s risk of cardiovascular disease later in life by 67 percent, and increases the odds of a stroke by 83 percent.

• Preeclampsia is associated with nearly triple the risk of cardiovascular disease in later life.

• Gestational diabetes, the new onset of Type 2 diabetes during pregnancy, is associated with a 68 percent higher risk of heart disease even if the diabetes resolves after delivery.

• Preterm delivery, defined as childbirth before 37 weeks, has been found to double the risk of developing cardiovascular disease and is strongly associated with stroke.

• Placental abruption, the separation of the placenta from the uterus before childbirth, is associated with an 82 percent increased risk for heart disease.

• Stillbirth is associated with a nearly two-fold risk for cardiovascular problems later in life.

Researchers are still trying to understand the connection between pregnancy complications and heart disease. It’s possible that some women had an underlying problem that was revealed by the pregnancy, Dr. Johnson says. “Pregnancy is really a stress test for a woman’s body,” she explains. On the other hand, some experts theorize that certain pregnancy conditions may cause physical changes that lead to disease later in life. Or it could be both.

Whatever the link, it’s important for women and their doctors to be aware of the risk. Many healthcare providers don’t ask about past pregnancies, Dr. Montana De La Cadena notes, so women should alert their physicians if they experienced these problems. She also recommends that women who had pregnancy complications be screened more closely for cardiovascular risk factors such as hypertension and Type 2 diabetes.

The impact on a woman’s health may not be seen for 10 years, or even longer, after her pregnancy, current research shows. “It can take years to develop,” Dr. Montana De La Cadena notes, adding that’s even more reason women should proactively pay attention to their health.

“Especially when they are in their 30s and 40s, women tend to be in denial when they see their numbers start to go up for blood pressure or cholesterol,” Dr. Montana De La Cadena says. “They blame it on stress. They tend to find excuses for their results, which is unfortunate because they are at an age when they could really benefit from preventive measures.”

Eating well, maintaining a healthy weight and exercising are even more important for women who experienced complications during pregnancy, Dr. Johnson agrees.

“Throughout the country there has been an increase in heart attacks and strokes in women younger than 55 years old, which highlights the importance of addressing heart risk factors,” Dr. Johnson says. “We want to make sure that women receive a timely diagnosis and timely treatment of heart disease, but we also want to do all we can to encourage prevention.”

Are you an expectant or new mom? To learn more about heart health after pregnancy, as well as other topics, check out the videos in the Mommy Matters Lecture Series offered through Boca Raton Regional Hospital’s Barbara C. Gutin Pre and Postpartum Program.

For more information about services offered at Christine E. Lynn Women’s Health & Wellness Institute, visit BRRH.com/Women or call 561-955-4437.

For more information about Miami Cardiac & Vascular Institute, visit BaptistHealth.net/MCVI or call 833-500-6284.