Cardiovascular disease (CVD) is now the leading cause of death among pregnant women and women who’ve recently had a baby.
Currently, approximately 1 to 4 percent of the 4 million pregnancies that occur in the U.S. each year are affected by CVD, according to the American College of Obstetricians and Gynecologists (ACOG).
With a timely diagnosis and a comprehensive care plan, most women with CVD can go on to have safe, successful pregnancies. However, due to the gaps and delays in properly diagnosing and treating CVD, many pregnant and postpartum women don’t receive the proper care for heart disease.
Consequently, heart disease accounts for about 26 percent of maternal deaths.
But experts are hoping to change those numbers with a new plan that could save the lives of new mothers.
A new set of guidelines recently published by ACOG focuses on how to recognize and treat heart disease in pregnancy in the May edition of Obstetrics & Gynecology.
The practice bulletin — called Pregnancy and Heart Disease — details the screening, diagnosis, and management of CVD recommended for women in the prenatal period all the way through to the postpartum period.
And ACOG wants doctors to start with this new method immediately to save lives.
“While evidence suggests that it can take years to implement innovation in clinical practice, today I implore my fellow practitioners to start using this guidance immediately to prevent more women from dying from complications in pregnancy and postpartum,” ACOG president Dr. Lisa Hollier, a professor in the department of obstetrics and gynecology at Baylor College of Medicine and medical director of obstetrics and gynecology for The Centers for Children and Women, said in a press conference held by ACOG on Friday.
“There is so much we can to do to prevent negative outcomes and ensure moms go home with their babies and are around to see them grow up,” Hollier noted.
First and foremost, ACOG recommends that all pregnant women be assessed for CVD using the California Improving Health Care Response to Cardiovascular Disease in Pregnancy and Postpartum tool kit algorithm.
This tool kit was released in 2017 by the Cardiovascular Disease in Pregnancy and Postpartum Taskforce to help clinicians identify who is at high risk for CVD.
According to the task force, nearly 90 percent of maternal deaths could have been identified as high risk for CVD requiring further evaluation and care had the tool kit been used during their pregnancy.
The new guidelines outlined by the ACOG aim to clearly differentiate between common symptoms of normal, healthy pregnancies and abnormal symptoms that may indicate an underlying heart issue.
They’ll also help doctors identify each woman’s individual risk factors — including race and ethnicity, age, hypertension during pregnancy, and obesity — as early as possible.
This is especially important for African American women who have a three to four times higher risk of dying from heart disease compared to white women.
Women who suffer from very severe heart conditions — including specific types of heart failure, valvular stenosis, and Marfan syndrome — should potentially be counseled against pregnancy and consider adoption or surrogacy instead, ACOG advises.
In addition, women who have moderate- or high-risk CVD should be treated by a multidisciplinary team of obstetrics, maternal-fetal medicine specialists, cardiologists, and anesthesiologists in a medical center that can provide a higher level of care.
“There are interventions that can be made to improve a woman’s outcomes in the peripartum should she have known CVD risks. Therefore, identifying women prior to pregnancy will lead to safer pregnancies and postpartum states for at-risk women,” Dr. Jennifer Haythe, a cardiologist with the Women’s Center for Cardiovascular Health at Columbia University in New York, told Healthline.
As a result, ACOG says that screening for CVD should not stop once the baby is born.
“The risk [for CVD] continues through pregnancy, may even accelerate somewhat postpartum, and it persists for quite some time,” Dr. James N. Martin Jr., chair of ACOG’s pregnancy and heart disease task force, said in the press conference.
For example, if a woman developed high blood pressure during pregnancy, she’ll have a much higher chance of developing heart disease postpartum. And if a woman does have or develops CVD during pregnancy, it will only get worse over the course of her life.
Unfortunately, nearly 40 percent of women do not return for postpartum care, Martin said.
“During the postpartum period, women are busy taking care of their newborn and as OB-GYNs we need to highlight that they still need to take care of themselves at this time,” Dr. Candace Fraser, an obstetrician-gynecologist and founder of Trinity Medical Care in New York, told Healthline.
According to Fraser, women are seen every few weeks throughout their pregnancy. In the last month, they are seen weekly. This frequency makes it much easier to screen and identify potential symptoms of heart disease during pregnancy compared to the postpartum period.
“The postpartum period often feels like a breakup, it’s another six weeks before you see them and so much can happen in that time,” Fraser said.
ACOG recommends that women with hypertension issues see a cardiologist or primary care physician within a week of delivery.
In addition, all women should undergo a comprehensive, cardiovascular evaluation about three months after delivery.
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During pregnancy, the body undergoes significant changes that put extra stress on the heart and blood vessels, according to Cleveland Clinic.
During the first trimester, the volume of blood in the body increases by about 40 to 50 percent. In addition, cardiac output — or the amount of blood pumped by the heart — rises by up to 40 percent.
Heart rate spikes, blood pressure drops, and many women start to feel fatigued and lightheaded.
This is what occurs in normal pregnancies. A heart condition puts even more stress on the body, which is why it’s crucial to try to identify any underlying heart conditions prior to pregnancy.
All woman need to understand their risk for developing heart disease — before, during, and after pregnancy.
Nearly 80 percent of the time, cardiovascular disease is entirely preventable, according to the American Heart Association.
“Often, an OB-GYN is a woman’s only doctor for the majority of her life,” Haythe said. “By screening women before, during, and after pregnancy, many women will be identified and treated, which should result in a significant decrease in CVD morbidity and mortality on the next decades.
The American College of Obstetricians and Gynecologists (ACOG) released a new set of guidelines outlining the screening, diagnosis, and management of CVD in prenatal and postpartum women.
Maternal heart disease is currently the leading cause of death among pregnant and postpartum women. By educating healthcare providers about the need to screen women early and often, ACOG hopes to improve maternal health and outcomes.