Heart disease is now recognized as the No. 1 indirect cause of maternal deaths related to pregnancy. According to the most recent data, cardiovascular disease was the cause of death for about one in four California women who died within a year of giving birth.
Although congenital heart disease is the most prevalent form of heart trouble in young women of child-bearing age, these women generally do well after giving birth.
Instead, many of the women who died had developed peripartum cardiomyopathy — a condition in which the heart balloons up and doesn’t contract well — during the late stages of pregnancy or the first five months after delivery.
All women are potentially at risk
“While the chance of acquiring peripartum cardiomyopathy is very low, no one is immune,” says Afshan Hameed, MD, professor of obstetrics and gynecology, maternal-fetal medicine and cardiology at UCI School of Medicine.
Certain women have a higher risk of developing cardiovascular problems related to pregnancy, particularly those who are:
- Of African American descent
- Older in age
Substance abuse may also substantially increase the risk. Still, heart disease can strike any woman, says Hameed, who is a national leader in studying the connection between heart disease and pregnancy.
“The biggest problem is under-recognition — by the patient and the provider,” she says. “That combination can be devastating.”
Toolkit helps providers identify at-risk women
Hameed is co-chair of the Cardiovascular Disease in Pregnancy and Postpartum Task Force of the California Maternal Quality Care Collaborative. The task force created a toolkit to help providers identify women at high-risk of developing heart disease during and after pregnancy who are in need of further evaluation.
The toolkit is intended to help generalists who provide maternity care to women:
- Labor, delivery and postpartum nurses
- Nurse practitioners
- Certified nurse midwives
- Family medicine physicians
- Emergency care specialists
UCI Health is conducting a study using the toolkit to screen all pregnant women for cardiovascular disease. In a presentation at 39th annual Society of Maternal Fetal Medicine in Las Vegas on Feb. 15, 2019, UCI Health physicians said they identified four pregnant patients with heart issues out of a total of 319 women screened. These are women whose heart problems would otherwise have gone undiscovered, Hameed says.
Cardiomyopathy, pregnancy share symptoms
Another obstacle is that the signs and symptoms of heart disease and pregnancy/post-partum are so similar. With both, Hameed says, women can experience:
- Lower-extremity swelling
- Shortness of breath
- Chest pain
Heart trouble can appear without warning
Peripartum cardiomyopathy can show up without warning during pregnancy.
There’s some thought that it may be the result of hormonal changes, but that has yet to be proven. Undetected preexisting heart conditions may also be revealed during pregnancy, which already places women in a state of low-level cardiovascular stress.
Too often, Hameed says, providers and patients dismiss such symptoms as harmless and simply typical of pregnancy.
Treatment can prevent bad outcomes
If a heart condition is diagnosed, treatment can prevent bad outcomes. Most of the disastrous consequences occur when the problem isn’t suspected.
Treatment usually involves standard medications for heart failure. Hameed says that 50 percent of women will improve to the point where their hearts are normal six months after starting medication. The other half may require medication for the rest of their lives.
“The death rate is low — less than 5 percent — but the ones who do die are the unrecognized and untreated,” she says. “Women with preexisting heart conditions actually do better because they have treatment plans.”
Report symptoms to your doctor
“My advice to patients is to report their symptoms — shortness of breath, chest pain, palpitations, fatigue, dizziness, lower-extremity swelling — to their doctor,” Hameed says.
“If your symptoms are affecting your day-to-day life, don’t disregard them. I recently had a patient who developed symptoms early enough, which saved her life. Patients need to recognize there is a problem and reach out.”