By Nadi Nina Kaonga, MD
Resident Physician in Obstetrics and Gynecology: Maine Medical Center
Board President: American Heart Association, Maine
Many pregnancy-related deaths are avoidable. Research shows early detection of cardiovascular disease (CVD) can prevent at least a quarter of pregnancy-related deaths. Pregnant people should learn the risk factors and talk to their health care teams about their personal risks before, during and after pregnancy.
CVD is the number 1 killer of new birth giving persons globally and it accounts for more than 25% of pregnancy-related mortality in the United States. Here in the US, we have the highest rate of pregnancy-related mortality among the world’s most developed countries. We have significant opportunity to improve pregnancy-related health outcomes by addressing CVD. Furthermore, by reducing heart disease in pregnancy, we can also improve heart health later in life. This is because ailments that arise during pregnancy may have lasting effects on long-term health.
Pregnancy adds extra strain on a pregnant person’s heart and blood vessels, which could lead to CVD as well as other health problems. Pregnancy’s metabolic demands — “nature’s stress test” — can expose heart issues that weren’t known before. This happens in part because the body is carrying more weight but changing hormones as well as the body’s interaction with the placenta also play a role.
Rates of high blood pressure (hypertension) both before and during pregnancy have increased in recent decades. Hypertension during pregnancy raises the risk of heart attack or heart failure. People with high blood pressure who get pregnant are also more likely to have pregnancy complications. Hypertensive disorders in pregnancy include pre-eclampsia (high blood pressure with signs of problems in organs such as the kidneys and liver) and eclampsia (pre-eclampsia plus new onset of seizures) can make it harder for a fetus to get enough oxygen and nutrients to grow, increasing the risk of an early delivery.
Age is another key risk factor for pregnancy-related death. People 35 and older are at higher risk of having or developing conditions that make pregnancy complications more likely. More than 80% of pregnancy-related deaths are in people aged 40 and older. Increasing age can also amplify racial inequities.
Differences in the quality of pregnancy care and in outcomes have been linked to factors related to structural racism. Racial disparities in pregnancy-related mortality are significant, peaking among black birthing people, who are over three times more likely than white birthing people to die of cardiovascular-related pregnancy complications. Systems in place that promote racial inequities can limit access to care and amplify pregnancy risks.
Obesity is another major risk factor and accounts for nearly one-third of a steep increase in U.S. pregnancy-related deaths. According to the CDC, from 2011 to 2015, pre-pregnancy obesity increased 8%, with the most severe obesity increasing 14%. Pregnant people with a BMI (body mass index) at or above 30 faced 3.7 times the risk of pregnancy-related death than other people. It’s also important to keep weight gain while pregnant within medical guidelines to reduce the risk of complications.
Those with high blood pressure, higher BMIs and/or a history of pregnancy-related CVD who are planning to get pregnant should work with your health care team to optimize your health and ensure any medications you are taking are safe for pregnancy. Be sure to discuss with your doctor and tell your team if you are taking any supplements, including high-dose folic acid supplements.
The American Heart Association recently published a scientific statement on the connection between heart disease and pregnancy, furthering the Go Red for Women movement’s focus on pregnancy-related health. The Association launched a maternal health channel of its Support Network and is funding research around fertility and pregnancy through the Research Goes Red initiative.
Read more about how the American Heart Association is improving health through education, research and advocacy at www.GoRedForWomen.org/pregnancy.