who have high-risk pregnancies or complications in childbirth
are up to eight times more likely to suffer heart disease
later in life. And many mothers — and their doctors — are
unaware of the danger.
research shows heart disease is a long-term threat for women
who develop diabetes or high blood pressure during pregnancy,
for example, or those whose babies are born prematurely or
doctors do not typically advise women about their risk or
counsel them to watch for symptoms, said Noel Bairey Merz, a
cardiologist and director of the Barbra Streisand Women’s
Heart Center at Cedars-Sinai Heart Institute in Los Angeles.
Merz said doctors can see heart attacks and strokes coming,
often 10 or 20 years ahead of time, if they are on the
lookout. "This isn’t rocket science," she said.
"We just have to figure out how we can find the women who
are at risk."
awareness of the link between pregnancy complications and
heart disease is prompting greater outreach to the public and
collaborative research between cardiologists and
obstetricians. That could help "make tremendous strides
toward reducing and preventing heart disease in women,"
said Bairey Merz.
recently started following a small group of women who’ve had
pregnancy or labor complications to further explore the heart
disease connection. In a separate study, Bairey Merz and other
researchers funded by the National Institutes of Health are
tracking 5,000 new moms at eight sites nationwide —
including Cedars — to fill gaps in knowledge about heart
health and develop recommendations for physicians.
Women’s Heart Alliance, an advocacy group started by
Cedars-Sinai and New York-Presbyterian Hospital/Weill Cornell
Medical Center, also works with obstetricians and other
providers to raise awareness among women and their doctors.
got a big advocacy and education piece that we should be doing
together," said Barbara Levy, vice president of health
policy for the American Congress of Obstetricians and
said education is critical because it reduces the likelihood
that women or their doctors will dismiss symptoms and concerns
that should be taken seriously. Cardiologists and women’s
health care providers are in a unique position to drive the
research agenda, Levy said. About 80 percent of U.S. women
give birth to at least one baby, and one-fourth have
complications during their pregnancies or labor. Researchers
are still trying to determine why such complications are
linked to later heart problems. Among hypotheses: Pregnancy
might contribute to vascular problems or unleash preexisting
can really mimic the stressors of age," said Margo
Minissian, a nurse scientist and researcher at the
Cedars-Sinai Heart Institute. "Pregnancy could
essentially be serving [as] a woman’s first physiological
said that women who have had pregnancy or labor complications
should tell their primary care doctors and have annual
screenings for high blood pressure or other potential health
problems. The American Heart Association and American Stroke
Association recommend, for example, that women who have had
preeclampsia — a potentially life-threatening spike in blood
pressure during pregnancy — be evaluated for heart disease
risk within one year of giving birth. Some women will need to
be medicated and may be referred to a cardiologist.
women who have had complicated pregnancies need not see a
cardiologist right after giving birth, Levy said — they
should just eat healthfully, be active and get enough sleep.
Immediately referring all of these women to cardiologists
could result in undue anxiety and unnecessary medical tests,
she said. "It will cost a lot of money and a lot of her
time while she is dealing with a baby."
of the Cedars-Sinai project, Minissian screens certain women
for cardiovascular risk within six months of delivery and
follows up with them every year. She also tries to help them
understand their risk and lead healthy lives to "avoid
the whole heart disease trajectory altogether."
women are going to have their eyes wide open," Minissian
said. "They are going to be looking for it and they won’t
allow people to pat them on the back and say, ‘Oh don’t
worry about that high blood pressure.’"
Minissian’s patients, Lara Hogan, gave birth to her son,
Zion, in May 2016.
in her living room in Topanga, Calif., Hogan recounted how she
had been monitoring her blood pressure during the pregnancy
because she was treated for hypertension in the past. Then,
during her 36th week, her pressure spiked — a sign of
and her husband, Chad, headed to Cedars-Sinai, where doctors
told her they needed to deliver the baby that night. But her
blood pressure did not come down after giving birth. In fact,
it kept rising.
had someone standing at my bedside monitoring me in case
anything happened," Hogan recalled. "I guess they
were so nervous that I was gonna have a stroke."
stayed in the neonatal intensive care unit for eight days
before he was released. Hogan went in and out of the hospital
as doctors tried to lower her pressure.
was a nightmare," she said. "All I dreamt about was
this moment for so many years. It was like the opposite of
everything I thought it would be."
doctors succeeded in bringing her pressure down and referred
her to a postpartum heart health program that Minissian leads.
Over the next several weeks, Minissian and others helped Hogan
take the right dose of medication and avoid the hospital.
Hogan checks her pressure on most days and plans to continue
seeing doctors to manage her long-term cardiac risk. Zion, who
recently celebrated his 1st birthday, just started walking and
likes to play with his toy xylophone and drums.
hopes to have another baby soon, so she has been seeing
Minissian to ensure her pressure is well-controlled before she
gets pregnant again. She knows she is at risk for heart
disease later in life because of her complications in
much as I don’t want to be thinking about my future heart
health or worrying about what’s going to happen when I am
older, this is priority No. 1 for my health right now,"
Hogan said. "For the sake of my son and my future