The study published in the Journal of the American Heart Association has identified three key categories that may increase a woman’s risk of suffering a pregnancy-related heart attack. It is vital that women and their healthcare providers are aware of the modifiable risks, non-modifiable risks, and obstetric risks so that appropriate care is sought and provided.
What the Study Shows
Researchers reviewed information from hospital inpatient stays over a 12-year period, which included data from over 11 million women aged 18-55 years. It reviewed information from pregnancy, labor, birth (including cesarean section), and the postnatal hospital stay. The overall risk of suffering a pregnancy-related heart attack is still low (0.008%), but when they do occur, most do so during the postnatal hospital stay and in women aged 30-39 years. It is thought that increased maternal age increases the risk of heart attack, because as age increases, so too does the presence of co-morbidities and health concerns. The study revealed numerous factors that may lead to an increased risk of suffering a pregnancy-related heart attack and broke them into three categories: modifiable, non-modifiable, and obstetric risk factors.
Modifiable Risk Factors
Atherosclerosis Smoking or other substance abuse Obesity Hyperlipidemia
How to Reduce Your Risk
Modifiable risk means that it is possible to reduce your risk by making some personal diet and lifestyle changes. Although it is best to make these changes before becoming pregnant, changes made at any stage can be beneficial to your overall health and the health of your baby. Nurse Practitioner and Midwife P. Fadwah Halaby advises that when it comes to nutritional changes and physical activity, “We don’t advocate dieting for weight loss during pregnancy, but certainly when someone shifts to a healthy, clean diet with appropriate portions, weight loss will normally occur in an obese person. Add to this the daily exercise that is recommended (walking for 30 min per day is adequate), there is an even greater chance that an obese pregnant person will lose weight while at the same time growing a healthy baby.” Obesity and hyperlipidemia (high cholesterol) contribute to atherosclerosis. Increasing physical activity and improving the quality of your food can help manage all these conditions. Quitting smoking not only reduces your LDL (“bad”) cholesterol but also lowers your risk of a heart attack and improves outcomes for your baby. Substance abuse other than tobacco can include marijuana, alcohol, prescription pain medication, or any other illegal drugs. All of these substances can be harmful during pregnancy and can increase your risk of a pregnancy-related heart attack.
Non-Modifiable Risk Factors
Pre-existing coronary artery disease Heart failure Previous valve replacement Atrial fibrillation Thrombophilia Race or ethnicity
How to Reduce Your Risk
Non-modifiable risks cannot be changed. Therefore, maternal-fetal OBGYN Dr. James Betoni advises that it is paramount that women connect with their healthcare provider early on in pregnancy if they have any non-modifiable risks. For help with substance use: https://www.findtreatment.gov For help to quit smoking: https://women.smokefree.gov/pregnancy-motherhood/quitting-while-pregnant By connecting early, your healthcare teams can ensure appropriate management plans are in place early to help control the risks and monitor for changes or concerns. Betoni explains that for healthcare providers, “it is critical to initiate maternal assessment for cardiovascular disease promptly and develop detailed management plans to mitigate risk in patients who are high risk for coronary artery disease.”
Obstetric Risk Factors
Pre-eclampsia Eclampsia Postpartum hemorrhage Placental abruption Postpartum infection Thrombotic event
How to Reduce Your Risk
Many obstetric risk factors occur due to the hormonal and chemical changes in the body during pregnancy, and therefore usually can’t be prevented by lifestyle choices, but they can be managed. Pre-eclampsia and eclampsia are considered hypertensive disorders of pregnancy in this current study. Hypertension refers to elevated blood pressure. Where blood pressure is a concern, it can be controlled by anti-hypertensive medications. It is important you seek advice from your doctor to ensure you are taking medications that are safe in pregnancy. Betoni explains that some women who are known to be at high risk for pre-eclampsia may benefit from low-dose aspirin therapy. This decision should only be made by your obstetric doctor because aspirin can have negative impacts on pregnancy if taken incorrectly. If you have a blood clotting disorder before or during pregnancy, your doctor may advise you to start anticoagulation therapy to reduce your risk of a blood clot lodging in one of your blood vessels (thrombotic event).
Modifiable or Non-Modifiable?
Increased maternal age was considered a non-modifiable risk, whilst Medicaid status was considered a modifiable risk factor. Although it could be argued that these factors may or may not fit within their assigned categories, the important message is that they both increase your risk of suffering a pregnancy-related heart attack. It is vital that you seek care early in pregnancy, understand symptoms of a heart attack, and seek care promptly if you experience symptoms of a heart attack.
Signs and Symptoms watch for:
Cardiologist Dr. Nicole Harkin advises pregnant women to watch out for common signs such as:
Chest painShortness of breathUnexplained fatigue with walking
Lesser known signs or symptoms in women can include:
NauseaJaw painBack painDiscomfort in the armsBreaking out in a sweat
“Some of these symptoms, like fatigue, can be normal in pregnancy—regardless, reporting them to your doctor, especially if you have risk factors for heart disease, is always recommended,” advises Harkin. She encourages all women to not be afraid to speak out and demand attention and care relating to their health. “Being a strong advocate for yourself cannot be underestimated…As individual women, if something feels wrong, we need to make sure our voices are heard.”
