Preventing cardiac problems during pregnancy

Although cardiovascular disease is the leading cause of death in the United States, it has not been widely recognized that many types of heart disease can and do affect women of childbearing age. But that is rapidly changing.

There is a growing awareness that during pregnancy, cardiac conditions can pose a danger to both mother and baby."

Loryn Feinberg, MD, Director of Women's Cardiovascular Health at Beth Israel Deaconess Medical Center (BIDMC)

Collaborating with specialists in BIDMC's Division of Maternal and Fetal Medicine and in the Department of Anesthesia, Feinberg and colleagues in the Women's Cardiovascular Health program provide a highly specialized treatment approach for women with underlying cardiovascular issues who want to become pregnant as well as for women who develop cardiac problems during pregnancy. "By working together, we can identify potential problems and carefully coordinate care before, during and after a woman's pregnancy and delivery," says Feinberg.

Before pregnancy: Have a preconception evaluation

For many patients, cardiac care begins before conception.

"A preconception cardiac evaluation is always recommended for women with underlying cardiovascular disease of any type," says Feinberg. Women who were born with congenital heart defects or have valve disease, coronary artery disease, as well as women who have arrhythmias or heart failure, should schedule an appointment for a cardiac evaluation before they become pregnant.

This comprehensive evaluation may include genetic assessment and evaluation of a woman's exercise capacity, as well as risk assessments for both mother and fetus. In addition, specific cardiac testing may be included.

Women who are becoming pregnant at later ages as well as women with a family history of heart disease or underlying risk factors can also benefit from a preconception evaluation.

"The average age of first-time mothers has steadily risen over the past several decades," says Melissa Spiel, DO, a Maternal and Fetal Medicine specialist at BIDMC who treats women with high-risk pregnancies . "With age comes a higher risk of heart complications, especially when compounded by preexisting conditions such as hypertension, diabetes and obesity. These may lead to a number of pregnancy complications, including a dangerous condition called preeclampsia."

By identifying possible issues prior to pregnancy, she adds, specialists can help mothers-to-be to avoid potentially serious problems.

During and after pregnancy: Awareness and prevention

Because many common symptoms of heart disease and heart attack are similar to symptoms encountered in mid-to-late-stage pregnancy, cardiovascular issues can be particularly difficult to identify.

"Shortness of breath, fatigue, palpitations, chest pain and ankle swelling may all be common complaints during pregnancy," says Spiel. "But it shouldn't be automatically assumed that these are just normal pregnancy symptoms." If these are not going away or are progressing , women should contact their doctor or health care provider and arrange to be seen right away.

Pregnancy puts a strain on a woman's cardiovascular system and by the third trimester, the amount of blood in a mother's body increases by as much as 50 percent, meaning the heart must work harder to pump blood. It's also normal for heart rate to increase.

"These normal changes during pregnancy can complicate preexisting cardiovascular conditions and, in some cases, can lead to the development of new cardiovascular issues," says Feinberg, adding that recent research has shown that women who have high blood pressure, preeclampsia, eclampsia or gestational diabetes during first pregnancies are more likely to develop long-term heart disease.

It's important to identify and treat women who are at risk of problems before they develop lifelong cardiac disease. Ideally, taking care of your heart before conception can be key to healthy outcomes during pregnancy. Managing weight and underlying conditions such as high blood pressure or high cholesterol can significantly reduce the risk of problems and help ensure that mother and baby stay safe and healthy."

Loryn Feinberg, MD, Director of  Department of Anesthesia

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