Taking Care of Your Heart: Heart health during pregnancy
At Stix, we know that cardiovascular health plays an important role in your quality of life and overall wellbeing. So, we’ve partnered with Dr. Nedda Dastmalchi, DO, MA, a physician and cardiology fellow at Temple University Hospital in Philadelphia, to get real about heart health in honor of Heart Month.
In continuing our Taking Care of Your Heart series, we asked Dr. Dastmalchi a few questions about gestational hypertensive disorders and high blood pressure during pregnancy. Optimal heart health before, during, and after your pregnancy is extremely important to your health and to the health of the baby. Keep reading to see what we learned.
What are gestational hypertensive disorders?
Dr. Dastmalchi: Gestational hypertensive disorders are a class of disorders that include hypertension, preeclampsia, and eclampsia. A hypertensive disorder is when you experience high blood pressure, which is when your heart has to work harder than normal to pump blood throughout your body.pregnancy-prep-combo
Having high blood pressure during pregnancy can cause a lower amount of blood that reaches the placenta, which will ultimately cause a decrease in the amount of oxygen and nutrients that reach the growing fetus. As a result, the baby can face a delay in growth, low birth weight, and/or premature birth.
Additionally, if you are diagnosed with one of these disorders, it can have effects on your heart even years later.
There are multiple gestational hypertensive disorders. Can you first tell us about gestational hypertension?
Dr. Dastmalchi: Gestational hypertension is diagnosed when the blood pressure is greater than 140/90 at 20 weeks gestation. You will have your urine tested to see if there is elevated protein, if so, you will also have the diagnosis of preeclampsia.
There aren’t many symptoms of high blood pressure, which is why it is typically referred to as the “silent killer.” Some patients can develop shortness of breath, chest pain or stroke-like symptoms when the blood pressure is extremely high. If these symptoms occur, you should go to the emergency room as soon as possible.
Here’s what to know about hypertension before, during, and after pregnancy:
- If you have a diagnosis of hypertension before your pregnancy, you will likely be diagnosed with chronic hypertension. You will be instructed to switch to blood pressure medications that are safe for the fetus.
- If you are diagnosed with hypertension during pregnancy, you will most likely be prescribed a blood pressure medication that is safe to use and will not harm your fetus. It is a good idea to purchase a blood pressure cuff to check your blood pressure at home to assure it is below 140/90 and responsive to the medication and lifestyle changes.
If your hypertension continues after you give birth, your diagnosis will then transition to chronic hypertension.
Let’s talk about preeclampsia. What is it and what signs should I look for?
Dr. Dastmalchi: Preeclampsia stems from gestational hypertension, or can result from chronic hypertension as well. Preeclampsia is hypertension with a blood pressure higher than 140/90, plus either one of the following:
- Protein in your urine
- Low platelet counts
- Elevated liver enzymes
- Inflammation in your lungs
- Visual changes
- Persistent headaches
Preeclampsia can occur anytime after 20 weeks gestation. Among women who are diagnosed with gestational hypertension, 10-25% of them will develop preeclampsia. Recognizing this condition is important because it can lead to serious or fatal complications for both you and the baby. Symptoms of this condition include:
- Severe headaches
- Changes to your urination, like decreased urination
- Changes to your vision
- Nausea or vomiting during the second half of your pregnancy
- Shortness of breath
Risk factors for preeclampsia include obesity, never being pregnant or having children, history of hypertension, chronic kidney disease, prior history of preeclampsia, lupus, and antiphospholipid syndrome. A family history of preeclampsia is also a large risk factor for developing this condition during pregnancy. This is where knowing your family history comes into play.
You also mentioned eclampsia. Can you tell us a bit more about it?
Dr. Dastmalchi: Absolutely. Eclampsia is a severe complication of preeclampsia characterized as the sudden occurrence of seizures and/or coma in a patient with a preeclampsia. This is a medical emergency that can prove to be fatal. Risk factors are gestational or chronic hypertension, advanced maternal age, and diabetes. Hypertension is one of the most common symptoms of eclampsia, which is reported in about 75% of cases. Other symptoms can be confusion and changes in mental state.
How do gestational hypertensive disorders affect your heart health?
Dr. Dastmalchi: Gestational hypertensive disorders must be monitored and treated during pregnancy by your obstetrician. After delivery, these disorders can improve; however, research shows that they are associated with an increased risk of heart disease.prenatal-multi-dha
Preeclampsia doubles your risk of heart disease and stroke while quadrupling your risk of hypertension. Because of this heightened risk, it’s best to follow your condition closely with your primary care doctor and screen for diabetes, high cholesterol, hypertension, and obesity annually. In addition, smoking increases your risk of heart disease exponentially so it’s advised to work with your health care provider to quit.
To prevent these potentially fatal outcomes from gestational hypertensive disorders, doctors recommend adopting a nutrition plan that is rich in whole grains, vegetables, fruits, and healthy fats like extra virgin olive oil and avocados.
If you have a prior history of cardiovascular disease and develop a gestational disorder, it would be advised to follow up with a cardiologist who specializes in the area.
What can you do to help prevent hypertension during pregnancy?
Dr. Dastmalchi: To help prevent high blood pressure during pregnancy, be sure to follow up with your obstetrician about your heart health and get screened for hypertensive disorders when necessary. Adopting a healthy lifestyle by eating whole foods, vegetables, fruit, unrefined grains and minimal sugar and animal protein can also help to prevent high blood pressure. Finally, refraining from smoking and making sure you are gaining the appropriate amount of weight during pregnancy can also aid in decreasing your risk for hypertension.
If you are concerned about developing hypertension during your pregnancy or have a family history of high blood pressure, you can also consider purchasing a blood pressure cuff to monitor your blood pressure regularly throughout pregnancy.
Is there anything else to know about heart health and pregnancy?
Dr. Dastmalchi: Let’s discuss postpartum cardiomyopathy. Postpartum cardiomyopathy is an uncommon, but potentially fatal condition of the heart that can occur one month prior to delivery and up to five months after. Incidence of this disease is rising, but that could be a result of increased awareness of the disease. 40% of cases have been found to be in Black women, who face this condition at disproportionate rates.
With postpartum cardiomyopathy, the chamber of the heart that is responsible for providing blood to the rest of the body becomes diseased, weak, and dilated. This can result in shortness of breath while walking or laying flat, chest pain, and worsening edema. Some of these symptoms are similar to what women experience late in pregnancy; however, if this feels out of the norm for you, advocate for yourself and have your obstetrician evaluate you for this condition.
To get a diagnosis, your doctor will have an echocardiography, or ultrasound of the heart, performed. If diagnosed, there should be multidisciplinary care with your obstetrician and a cardiologist who is an expert in the area so that you can receive the proper medication and monitoring to help your heart regain its normal function.
Research is still searching to understand why this occurs during pregnancy, but initial research indicates that hormone fluctuations and the immune system play a role. Initial screening for thyroid abnormalities, anemia, and electrolyte abnormalities should be done to make sure they are not contributing to this heart issue.
As the medical community aims to better understand this condition, there are ways to decrease your risk by managing hypertension and diabetes, stopping smoking, and embracing nutritional diversity, as I stated earlier, in addition to exercising as tolerated.
Don’t miss a beat this Heart Month. Stay tuned for more heart health education throughout the month of February.
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