May 04, 2020
Women living with cardiovascular disease have a higher risk of pregnancy complications and should receive specialized care, the American Heart Association recommended Monday.
In a scientific statement published in the AHA's medical journal Circulation, a group of doctors called for such mothers and their fetuses to receive care from a cardio-obstetrics team or health care providers experienced in high-risk pregnancies.
"Cardiovascular diseases are the leading cause of pregnancy-related death and are increasing possibly because women are having babies at older ages and are more likely to have preexisting heart disease or heart disease risk factors," said Dr. Laxmi Mehta, a cardiologist at Ohio State University who helped write the statement.
The rate of pregnancy-related deaths more in the United States more than doubled between 1987 and 2015, jumping from 7.2 to 17.2 deaths per 100,000 live births.
Pregnancy at age 35 or older also is associated with a higher risk of premature birth, chronic hypertension, preeclampsia and gestational diabetes.
Heart disease refers to various conditions that affect the heart, including damage to blood vessels, heart rhythm problems and heart defects. Blood vessels that become narrow or blocked can lead to a heart attack or stroke.
Mehta advised women who have a preexisting cardiovascular condition to be counseled by a cardio-obstetrics team.
"Women should understand fetal risks and the risks to their own health posed by heart conditions before becoming pregnant," she said, adding that there may be changes to medication management and procedures during the pregnancy.
For instance, statins should be discontinued at least one month before attempting pregnancy because they can cause birth defects, she said.
Once pregnant, women with cardiovascular disease need an individualized delivery plan and should be closely monitored, especially for spikes in blood pressure, according to the scientific statement.
Preeclampsia – high blood pressure during pregnancy – can occur after 20 weeks of gestation in women who previously had normal blood pressure levels. This can lead to liver or kidney dysfunction, headaches, vision changes and fluid in the lungs. It also is the leading cause of premature birth and cesarean delivery.
Heart rhythm disorders also are on the rise in pregnant women. They typically do not cause any serious problems, but more complex arrhythmias can lead to cardiac arrest or stroke.
Cardiac care should continue postpartum to prevent the development of any further cardiac risk factors or conditions, according to the statement. Research has shown that women who experience preeclampsia during pregnancy are 71% more likely to die from heart disease or stroke during their lifetime than women with no history of it.
It's essential for women to understand the risks to themselves and their fetuses, Mehta said. Getting proper medical care and living a healthy lifestyle can help reduce pregnancy complications and future health issues.