More evidence
suggests pregnancy is a kind of stress test for the heart, revealing a woman’s
pre-existing predisposition for a heart attack or stroke years after giving
birth.
Women who
developed high blood pressure while pregnant had a 63% increased risk for
developing cardiovascular disease later in life, researchers reported this
month in the Journal of the American College of Cardiology.
“This is a risk that arises over the years and persists for decades after
delivery,” Jennifer Stuart, the study’s first author and an associate
epidemiologist in the division of women’s health at Brigham and Women’s
Hospital in Boston, told TODAY.
“I try to take the posture of empowering women and trying to find ways to
use this to reduce risk because unfortunately once you have it — much like
having a family history of cardiovascular disease — you can’t get rid of it.”
’Failed’ stress test
The risk emerged
about 10 years after the first birth for women who had preeclampsia — high
blood pressure and protein in the urine during pregnancy, the study found.
These patients were more likely to have a coronary artery event, such as a
heart attack, compared to women who had a normal blood pressure while pregnant.
For women who
had gestational hypertension — a spike in blood pressure during pregnancy, but
without kidney problems — the risk appeared 30 years after the first birth.
These patients were more likely to have a stroke.
While it’s not
fully known if the higher risk is due to some sort of damage that happens
during that complication in pregnancy, most researchers believe it’s simply
unmasking a health problem that’s already there, Stuart said. “Essentially, a
‘failed’ stress test is having some of these complications,” she added.
The risks
persisted even when the researchers adjusted for risk factors such as having a
family history of heart disease or having a BMI that fell into the overweight
or obese category before pregnancy, which was surprising, Stuart said.
Four factors account for majority of the risk
The findings
were based on data from more than 60,000 women in the Nurses’ Health Study II
who were followed for almost 30 years. Researchers analyzed their pregnancy
history, cardiovascular health history, BMI and other health records.
About 10% of the
participants had gestational hypertension and preeclampsia in their first
pregnancy.
Researchers
found 64% of the increased cardiovascular risk linked with these conditions
later in life could be explained by “four simple things that we know how to
measure and target,” Stuart said: developing chronic high blood pressure after
giving birth, high cholesterol, diabetes and gaining weight.
“This study reinforces how important it is for women and their healthcare
providers to address known cardiovascular disease risk factors, such as obesity
or having high blood pressure, while thinking about starting a family and then
during and after during pregnancy,” said Victoria Pemberton, a researcher at
the National Heart, Lung and Blood Institute, in a statement. NHLBI funded the
research.
Doctors need to
ask women about their history of pregnancy complications such as gestational
hypertension or preeclampsia, and patients who’ve experienced those
complications should be informed that they have an increased risk for heart
disease, Stuart said.
She was
concerned this information often "gets stuck or siloed" at the
obstetrician’s office and doesn’t get transferred to a woman’s primary care
provider.
“This subgroup of women… might be under the radar of preventive
cardiologists, internists and family practitioners,” doctors wrote in an
accompanying editorial comment for the study. There’s a need for extended
follow-up beyond the 12-week postpartum period for women with pregnancy
complications, known as the “fourth trimester,” they added.
It’s also
important for women to adopt healthy habits, such as regular exercise and a
heart-healthy diet, earlier in life — before developing these risk factors,
Stuart said.
“(We want) women to feel empowered to use this information to improve
their health rather than be overwhelmed or daunted by an increased risk after
what can be a really complicated pregnancy,” she noted.
Source: Today
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