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What should you expect when you're expecting? Likely not a heart condition

February 28, 2014

In California, heart disease is the leading cause of pregnancy-related deaths. While some women with pre-existing cardiac conditions may need to take special precautions before and during pregnancy, other expecting moms may have an unidentified heart condition that isn’t diagnosed until or after delivery.

As a woman’s body undergoes many changes during pregnancy, maternal fetal medicine experts with UCI Health strongly encourage the identification of patients who not only present specific risk factors and symptoms of potential heart disease, but also those who complain repeatedly of common pregnancy-related symptoms that affect their daily routines.

“Typically speaking, most childbearing women are young and healthy but there are young mothers – in their 20s and 30s – who may have risk factors for heart disease that haven’t manifested yet,” said Dr. Afshan Hameed, cardiologist and maternal fetal medicine specialist with UCI Health. “These women may live for years with undiagnosed cardiac conditions and are unknowingly putting their health at risk as well as their developing babies.”

During pregnancy, many changes occur in a woman’s body, including the workload of the heart. These changes can include: an increase in blood volume by fifty percent to ensure all organs are receiving enough blood supply, an increase in cardiac output of up to forty percent due to the increase in volume, an increase in the heart rate of up to 15 beats per minute, and – possibly – a decrease in blood pressure due to hormonal changes.

While these changes are normal during a pregnancy, some mothers-to-be experience fatigue, dizziness, and shortness of breath, which can also mimic the hallmark signs of cardiac disease as well as complicate the diagnosis.

Hameed recently led a research study analyzing why California’s maternal death rates have nearly tripled in the last decade from 5.6 per 100,000 live births in 1996 to 16.9 per 100,000 live births in 2006. In the 2.1 million recorded live births in California from 2002-2005, 732 women died from pregnancy-related deaths. Nearly 25 percent of those 732 deaths were caused by some form of cardiovascular disease. Notably, only six percent of the women had been diagnosed with a heart condition prior to their pregnancy.

The study also determined that almost 30 percent of all cardiovascular disease pregnancy-related deaths were determined to be potentially preventable (and 35 percent of cardiomyopathy deaths).

As Hameed says, “this should be a big wake-up call for doctors. It is imperative that health care providers do a better job recognizing heart disease triggers such as changes in blood pressure, heart rate, or if the woman is experiencing excessive shortness of breath, fatigue, or anxiety. These may be indicators for heart disease and should be evaluated immediately.”

In the study, UCI Health researchers also concluded that in 65 percent of the pregnancy-related deaths, the diagnosis was either incorrect or delayed; 47 percent of providers had given ineffective or inappropriate treatments; and 41 percent of pregnant women were misdiagnosed. Nearly 30 percent of the expecting mothers did not recognize their symptoms as cardiovascular-related.

Additionally, nearly 25 percent of the women who died of cardiac causes had been diagnosed with high blood pressure during their pregnancies.

For pregnant women with multiple cardiovascular risk factors such as obesity, diabetes, high blood pressure or family history of cardiovascular disease, OB-GYNs should maintain a high index of suspicion and may consider consultation with maternal fetal medicine specialist or a cardiologist.

Hameed recommends that expecting mothers who have high blood pressure or preeclampsia leading to pre-term delivery (before 37 weeks), to be evaluated postpartum to ensure there is no residual signs of hypertension or diabetes.

“Women who have preeclampsia or gestational diabetes and preterm delivery have up to an eight to 10-fold increased risk for developing cardiac disease later in life,” says Hameed. “These women need to be identified as high-risk patients and should have a follow-up care three to six months after delivery. If these conditions are treated appropriately, the risk of these women having future cardiac issues is greatly reduced.”

For overall heart health, Hameed promotes a heart-healthy diet and lifestyle. Additionally, babies who are born pre-term or are growth restricted have a higher risk of developing chronic illnesses as grow up to be adults.

“Expecting mothers should stick to healthy eating and living as that will promote healthy development of their baby in utero. It’s also important to keep making healthy lifestyle decisions once the baby arrives so families can keep their health and wellness on the right track.”

In the United States, heart disease is the leading cause of death in women (one out of every three) and is more deadly than all forms of cancer combined. Only one in five women believes that heart disease is her biggest health threat.

Additional study co-authors are Elyse Foster, M.D.; Christy McCain, M.P.H.; Christine Morton, Ph.D.; and Elliott Main, M.D. The California Department of Public Health, Maternal Child and Adolescent Health funded the study, with support from the California Maternal Quality Care Collaborative and the Public Health Institute.

This research study was supported by federal Title V MCH funds to the California Department of Public Health, Maternal Child and Adolescent Health Division and the California Pregnancy-Associated Mortality Review.

Hameed is a Board Certified Cardiologist and Maternal Fetal Medicine Specialist. UCI Health is a leader in maternal fetal medicine and has one of California’s few combined regional perinatal/neonatal program to treat high-risk pregnancies, deliveries and newborns. UC Irvine Medical Center is the only facility in Orange County offering specialized care in one location for high-risk expectant mothers and their babies.

UCI Health comprises the clinical, medical education and research enterprises of the University of California, Irvine. Patients can access UCI Health at physician offices throughout Orange County and at its main campus, UC Irvine Medical Center in Orange, Calif., a 412-bed acute care hospital that provides tertiary and quaternary care, ambulatory and specialty medical clinics, behavioral health and rehabilitation. U.S. News & World Report has listed it among America’s Best Hospitals for 13 consecutive years. UC Irvine Medical Center features Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program, Level I trauma center and Level II pediatric trauma center, and is the primary teaching hospital for UC Irvine School of Medicine. UCI Health serves a region of more than 3 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook and Twitter.

About the University of California, Irvine: Located in coastal Orange County, near a thriving employment hub in one of the nation’s safest cities, UC Irvine was founded in 1965. One of only 62 members of the Association of American Universities, it’s ranked first among U.S. universities under 50 years old by the London-based Times Higher Education. The campus has produced three Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Michael Drake since 2005, UC Irvine has more than 28,000 students and offers 192 degree programs. It’s Orange County’s second-largest employer, contributing $4.3 billion annually to the local economy.