From the February 2018 issue

Heart Health and Pregnancy: What Moms Need to Know

An obstetrician at Beaumont explains how heart health impacts your pregnancy, your baby and your risk factors down the line.

Brought to you by Beaumont

When you have a baby on the way, it’s natural to focus on the new, tiny heart beating inside you a bit more than your own.

Pregnancy shouldn’t keep you from prioritizing your own heart health, though. In fact, experts say good heart health – both before and during pregnancy – is a key factor in positive outcomes for mom and baby.

It’s something women should think about, says Dr. Jay Fisher, a Beaumont OB-GYN with more than 20 years of experience and who has a private practice in West Bloomfield.

“The fortunate thing is most pregnant patients are healthy and they’re not really at a stage in life where they worry or think about heart disease, but obviously heart health is something that people need to be cognizant of throughout their life,” he says.

Pregnancy and heart health can be related in ways you wouldn’t expect. A pre-existing heart condition could affect a pregnancy, new heart symptoms could develop during gestation or a condition like preeclampsia could even change a woman’s risk factors for heart disease post-pregnancy.

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“During pregnancy, the amount of blood the heart can put out goes up by almost 50 percent, so the strain that is on the heart is amplified,” Dr. Fisher says. “People who might have never had symptoms before may start to develop symptoms in pregnancy from a condition they were unaware of.”

How it’s monitored

On the bright side, nine months of prenatal care usually means frequent and close monitoring so potential heart problems are picked up quickly. All prenatal exams include a blood pressure check, for example.

“That’s one of the first signs or symptoms that we have oftentimes of impending heart disease,” he says.

Your OB-GYN will also ask about any preexisting heart disease, congenital heart defects or other things in your health history that could affect your heart. Women should also report any heart symptoms – like shortness of breath without exertion, irregular heart rate, a persistent feeling that your heart is racing, or chest pain – to their doctor right away.

“If they don’t resolve with rest or go away after a short period of time, we’d want them to call or come in to be seen,” Dr. Fisher explains, adding that an EKG or 24-hour heart monitor may be used to check for problems. “The majority of patients without any cardiovascular history do fine but there are a lot of cardiac and cardiovascular changes that occur during pregnancy that can unmask underlying heart disease that was previously undiagnosed.”

What could go wrong

Because of the extra strain on the heart during pregnancy, knowing about any heart conditions right away is critical.

“If the heart has been damaged by a previous myocardial infarction or a cardiomyopathy, those are things that can have really significant complications for the mom and the baby,” Dr. Fisher says. “If that was the case, we usually take a multi-disciplinary approach to managing the pregnancy with a high-risk OB doctor and a cardiologist involved in managing the care.”

Depending on the situation, many conditions can be managed without medication, but if necessary, several medications are safe to use during pregnancy. In some cases, the baby’s delivery may need to be managed differently as well.

“Somebody with severe heart disease may still deliver vaginally but we might not want them to push for a sustained period of time or have a long second stage of labor,” he says.

The preeclampsia precursor

Preeclampsia, a common pregnancy complication involving high blood pressure and protein in the urine, has been found to increase a woman’s risk for cardiac disease later in life, Dr. Fisher says. While researchers are still trying to find the exact cause of preeclampsia, there are ways to reduce the risk.

“We have found ways to reduce the incidence of preeclampsia including reducing underlying chronic hypertension before women get pregnant,” he says.

Preeclampsia can increase the risk of preterm delivery, having a baby with low birth weight and other serious complications. The condition is also more common in women who have gestational diabetes, which is more common in women with obesity.

“All of these things kind of tie together,” Dr. Fisher says. “(Preeclampsia) doesn’t change your risk right away but there are some pretty significant studies … that show that women are at an increased risk for cardiac disease later in life if they have a history of preeclampsia, especially if they had a preterm birth or small baby.”

Know your risk

Being aware of the risk is key, since treatments and other interventions are available. Some women are treated with aspirin during pregnancy, for example.

“It’s an issue that everyone should be aware of because there are modifiable risk factors that women can pay attention to, hopefully even before they get pregnant,” Dr. Fisher says, including eating healthy, not smoking, watching their weight and keeping a normal cholesterol level. “Those are things that are going to reduce the chances of any underlying cardiovascular problem causing a significant effect on the pregnancy.”

Women should also know that while the overall incidence is quite low, the risk of a heart attack is three times higher in pregnant women compared to non-pregnant women of the same age.

“That incidence is actually rising because we have more women of advanced maternal age who are getting pregnant,” Dr. Fisher says. “As the average age of pregnant patients gets higher, we’re going to see more cardiovascular disease in that patient population, too. That’s why prenatal care, and good health before pregnancy, is so important.”

To find a Beaumont doctor or make an appointment, visit beaumont.org.

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