Pregnancy and your heart

Most women expect their hearts to undergo a transformation during pregnancy: That it will swell with love, growing and expanding to nurture their precious babies. But for many women, this metaphorical change is not their only consideration. Many women find pregnancy puts added physical stress on their hearts, leading to new or previously undiagnosed heart disease. Other women have pre-existing conditions that need extra monitoring during pregnancy. “Recent studies have shown that many pregnant women in the United States are not in good heart health,” explains Bridget Beck, MD, a cardiologist with Denver Heart at Swedish Medical Center.

“There is a newer term that describes this important field: cardio-obstetrics. Experts in cardio-obstetrics are encouraging women to take an active role in their heart care—especially during the vulnerable time of pregnancy.”

Pregnancy as a Natural Stress Test on Heart

A woman’s body experiences many changes during pregnancy to allow her body to nourish and grow her unborn child. Many of these changes affect the heart—blood volume in the body increases by 40-50%; cardiac output increases 30-40%; heart rate can increase by 10-15 beats per minute and blood pressure can decrease as hormones released during pregnancy cause blood vessels to relax. All these changes lead to feelings of fatigue, shortness of breath and lightheadedness. To some extent, these changes are normal and expected. But, for some women, this added stress may put enough pressure on the heart that complications arise.

“Heart disease is the leading cause of death in pregnant and recent postpartum women,” Dr. Beck explains. “It is important to keep an eye out for symptoms such as extreme swelling, fainting, chest pain, fast heartbeat, and severe shortness of breath while lying down. While some of these symptoms are normal with pregnancy, if they are severe, persistent or unexplainable, it is important to talk to your doctor.”

Anyone can develop heart disease during pregnancy or in the postpartum period, but there are certain factors that may increase your risk: being 40 years or older, having prior heart disease, being obese, having high blood pressure, coming from an African American descent.

“Another important correlation of pregnancy and heart health is that adverse events of pregnancy often indicate the likelihood of future heart disease,” Dr. Beck details. “For example, if you are experience gestational diabetes, preeclampsia or have a premature birth, it is important to keep talking about that with your doctor. These events may give us an indication that heart disease will develop in the next decade or so. By working with a cardiologist, we can help you take preventative action to keep your heart healthy before any serious problems develop.”

Congenital Heart Disease, Advanced Maternal Age

As medicine has improved during the last several decades, women who are born with serious heart conditions are able to live longer, more normal lives which often includes pregnancy. When women with congenital heart disease become pregnant, it is especially important for them to work closely with a cardiologist as well as her OB/GYN during her pregnancy. “Advanced heart treatments are allowing women with congenital heart disease to be able to experience pregnancy and start a family. It is especially important for these women to have a cardiologist as an active member of their obstetric care team,” Dr. Beck says.

Because of the multitude of changes on the body and the extra work the heart must perform during pregnancy, we want to closely monitor and treat these women before, during and after their pregnancies.”

Advanced maternal age is another reason to seek dedicated heart care during pregnancy. Women who are becoming pregnant later in life (ages 35 and older) are already at a higher risk for heart disease, simply because of their age. When coupled with pregnancy, the women’s risk only increases. “Women in this category should consider consulting with a cardiologist to help identify potential issues during and after pregnancy,” Dr. Beck says.

Cardiology for Pregnant Women

While your OB/GYN will monitor your heart health during your regular visits, women in these higher risk categories should consider seeking treatment from a cardiologist who offers cardio-obstetric care. “For women who are pregnant and looking for support in heart care, we provide risk factor assessments, education and specialized treatment based on her specific needs,” Dr. Beck highlights. “By establishing a relationship with us before you get pregnant, we can work closely with you during the prenatal, pregnancy and postpartum period to ensure you and your baby are as healthy as possible.”

“Many women focus their concern on the health of their babies, which is important. But women should also remember that caring for their own bodies and hearts is vital as well,” Dr. Beck stresses.

“It’s only when you are in your best health, that you can be the best caregiver for your family.”

To learn more about why more patients are saying “Take me to Swedish” for their emergency, heart and OB care, visit SwedishHospital.com/er.

Bridget Beck, MD, FACC, is a board-certified, Cleveland Clinic fellowship trained cardiologist with Denver Heart at Swedish Medical Center. Dr. Beck earned her undergraduate degree from the University of Notre Dame. She moved on to Chicago for medical school and internal medicine residency where she attended Loyola University and University of Chicago, respectively. From there, she was accepted to the prestigious Cleveland Clinic to complete a fellowship in cardiology. Her medical interests include cardiac imaging including echocardiography, trans-esophageal echocardiography and nuclear stress testing, with a special interest in valvular heart disease. She also has an interest in women's cardiac health. She is board certified in cardiovascular disease and adult echocardiography.