In 2016, a study published in the journal Obstetrics and Gynecology set off alarm bells that are still reverberating among women’s healthcare providers.
Researchers found that from 2000-2014, deaths among U.S. women during pregnancy or shortly after childbirth increased by more than 26%. The leading cause was heart disease.
Causes of heart disease in pregnancy
Dr. Ildiko Agoston, a University Health System cardiologist who specializes in treating expecting mothers with heart problems, says a sedentary lifestyle is one reason a pregnant women may be at greater risk. Being overweight or postponing pregnancy are also contributing factors.
“So we have women who tend to have babies in their 30s or early 40s. And by that time more people develop high blood pressure, diabetes or the risk for these conditions, which contribute to heart problems,” said Dr. Agoston.
Some of Dr. Agoston’s patients have heart conditions that were treated when they were children. They think they’re OK, but their problems reemerge during pregnancy.
The majority of high-risk women, however, develop heart problems after becoming pregnant. They may struggle with preeclampsia, a condition characterized by high blood pressure, or gestational diabetes, caused by hormonal changes. A report published by the American College of Obstetricians and Gynecologists says low-income women and women of color are most in jeopardy for complications or death. One reason is limited access to affordable healthcare.
One woman’s heart symptoms and treatment
Amanda Campos lived with a heart defect for years but didn’t know it. At age 23, her first symptoms were typical for women at risk for heart failure. She grew short of breath while walking five minutes from her car to her workplace. She began having chest pains after climbing a short flight of stairs.
Campos, a nurse, made an appointment with a cardiologist who discovered she had an atrial septal defect – a small hole in the wall of her heart between the two upper chambers. It had been there since birth.
The doctor assured her that having a family wouldn’t pose a problem. But when she became pregnant two years later, her body responded by pumping more blood and the hole in Campos’ heart grew. The risks to her health grew with it.
“Because of the hole in my heart, I am a high risk for a stroke,” she said, repeating what she’s learned since being treated by Dr. Agoston. “So, if I get a blood clot in my legs – for most people, that would mean it goes into their lungs. For me, it means it would go straight up to my brain,” said Campos.
Help for maternal heart patients
Dr. Agoston says women who know they have heart conditions should consult their cardiologist before getting pregnant. Specialists may be able to repair a defect. A patient may be able to improve her health by losing weight or addressing other concerns before facing the stresses of pregnancy. In some cases, the doctor may recommend the woman not become pregnant.
“I have had those difficult discussions way too many times in my life because of the field I’m in,” said Dr. Agoston. “And I have to tell you that I cry with them when I say you shouldn’t get pregnant, because I know how much they want to have their own kids.”
For heart patients who decide to attempt a healthy delivery, Dr. Agoston assembles a multidisciplinary team. She usually includes an anesthesiologist who will assist with the birth. A cardiothoracic surgeon, pulmonologist or other specialists may be called in. They discuss whether to deliver the baby vaginally or by cesarean section, and how to limit the stress on the mother’s heart during labor. They plan for complications that might affect the baby.
Reversing maternal heart disease
While cardiac maternity teams are saving women’s lives, the long-term goal is to prevent heart problems during pregnancy.
Dr. Agoston believes that will require multiple efforts: greater access to healthcare; educating young women about symptoms, prevention, and treatment; and educating providers too.
“They need to understand when they should refer their patients further. I'm talking about general practitioners, family doctors, maternal-fetal medicine doctors and OB-GYN doctors.”
Because she saw a cardiologist early and has a team of specialists standing by, Campos feels good about her chances of having a successful delivery. She’s relieved that tests show her unborn daughter, Ariel, is healthy.
Through our partnership with UT Health San Antonio, we provide the most comprehensive Maternal-Fetal Medicine program in South Texas. As a Level IV Maternal Facility, our Maternal-Fetal Medicine specialists have completed additional training to learn best evidence-based practices for the care of women and their developing baby during their high-risk pregnancy.