Many pregnant women are more concerned with back problems, eating a healthy diet, and staying fit, a growing body of research shows that pregnancy comes with a hidden danger: an increased risk of heart attack and heart disease.
While uncommon, it is possible for pregnant women to develop rare heart conditions or suffer a heart attack, even though they do not have traditional risk factors for cardiovascular disease.
Sometimes heart disease is the result of previously undiagnosed heart conditions, but it can also be caused by the strain of pregnancy.
Pregnancy Strains the Heart
During pregnancy, the heart must work harder to pump more blood and support a growing fetus.
This is because blood volume increases up to 50% and maternal heart rate rises about 10-15 beats per minute.
This can worsen an existing heart disorder or cause a disorder to produce symptoms for the first time in a woman’s life.
Women who already have a weakened heart may not be able to tolerate this increased stress.
Unfortunately, many women are unaware of a heart condition until symptoms develop during pregnancy.
Cardiovascular Disease Is an Uncommon Pregnancy Complication
Cardiovascular disease (CVD) is a complication in about 1-4% of all pregnancies, according to the Cleveland Clinic.
The most common preexisting condition is congenital heart disease. Hypertension is the most common type of cardiovascular disease acquired during pregnancy.
Gestational Hypertension Increases the Risk of Heart Disease
Hypertension or high blood pressure happens when the pressure of blood pumped through the arteries is too high.
When uncontrolled, hypertension increases strain on the heart and blood vessels by making them work harder with reduced efficiency.
Over time, high blood pressure can damage arteries and increase the risk of heart attack, stroke, arrhythmia, and other forms of heart disease.
Hypertension is the most common medical issue during pregnancy, affecting about 1 in 10 pregnancies.
This condition can occur before pregnancy or develop during pregnancy. In either case, it can be dangerous to the mother and baby if untreated.
Gestational hypertension refers to a woman developing high blood pressure after 20 weeks of pregnancy.
Sometimes this condition develops into preeclampsia, a more serious condition associated with damage to the brain, liver, kidneys, and other organs.
Along with decreasing blood flow to the placenta and increasing the risk of placental abruption, hypertension during pregnancy increases the risk of heart disease later.
Pregnancy Increases the Risk of a Heart Attack
According to research by the American College of Cardiology, pregnancy raises the risk of women suffering a heart attack. Even worse, heart attacks during pregnancy are usually more serious with more complications.
Research has found that most pregnant women do not show traditional risk factors for cardiovascular disease like diabetes, high cholesterol, or hypertension, yet still, tend to suffer serious heart attacks.
Among pregnant women, the death rate from a heart attack was 7%, or 2-3x higher than non-pregnant patients of similar age.
The study found that heart attacks among pregnant women occur through different mechanisms than other heart attacks.
Most heart attacks are caused by atherosclerosis or narrowing of the arteries due to a build-up of plaque.
Among pregnant women, this was the cause in just one-third of heart attacks.
Coronary dissection, or separation of the layers of the artery wall, was most common among pregnant patients, a condition that’s very rare among people who aren’t pregnant.
Heart attacks occur in about 1 in 16,000 pregnancies. While this is a low risk, it’s still 3-4x higher than in non-pregnant women.
PPCM is a Rare Form of Pregnancy-Related Heart Disease
Sometimes the walls of the heart or myocardium are damaged after delivery or during the later stages of pregnancy.
This specific time frame is referred to as the peripartum period and this condition is called peripartum cardiomyopathy or postpartum cardiomyopathy (PPCM).
PPCM is a rare complication of pregnancy with unknown causes. According to the American Heart Association, just 1,000 to 1,300 women develop PPCM in the U.S. every year, but it is more common in other countries.
Researchers have found that the disorder usually occurs in women carrying multiples, those who have had multiple pregnancies, mothers who are 30 or older, and women who have preeclampsia.
Sometimes heart function fails to return to normal after pregnancy. This increases the risk of the disorder occurring in subsequent pregnancies.
PPCM can cause severe heart failure in some women that may require a heart transplant or mechanical support.
This woman explains her experience with pregnancy-induced heart failure.
Pregnant women who develop PPCM are usually treated with several classes of medication to prevent fluid from collecting in the lungs and help the heart recover. Prompt diagnosis and treatment can improve the odds of recovering normal heart function.
Heart Disease Is the Leading Cause of Pregnancy-Related Deaths
In the United States, heart disease is responsible for 52% of pregnancy-related fatalities, according to the American Heart Association.
This may be surprising as most women who are pregnant are fairly young and in good health.
The most frightening aspect of this statistic is just 6% of women who died from heart disease while pregnant had been diagnosed with a heart condition.
Researchers found that women who died from pregnancy-related heart disease were more likely to be obese, African-American, or had documented substance abuse compared to women who died of other causes. About 25% of the women had high blood pressure during pregnancy.
It Can Be Hard to Spot Heart Disease During Pregnancy
Pregnant women are usually under the age of 35-40 and healthy. To many doctors, heart disease and pregnancy just do not seem to go together.
This already means that physicians are less likely to screen for and detect signs of heart disease among pregnant patients.
Spotting heart disease is made even more difficult by the fact that typical signs of cardiovascular disease are also common symptoms of a normal, healthy pregnancy.
For example, heart murmurs, which are soft murmurs heard between heartbeats, are common in up to 90% of women.
Yet, murmurs may also be a symptom of a condition that causes the heart to beat too fast and handle an excessive amount of blood.
Ankle edema, or swelling, is also a normal aspect of pregnancy caused by extra fluid and blood.
Pregnant women may develop fluid retention in the feet, ankles, legs, hands, and face which helps the body expand throughout pregnancy.
Edema of the legs and ankles can also be a sign of heart failure, which causes a build-up of fluid.
Many pregnant women report fatigue. Some women feel very tired throughout their whole pregnancy, but it’s most common during the first trimester and third trimester.
Extreme fatigue can also be a symptom of heart disease, and it can be a major warning sign of heart failure.
Shortness of breath is another symptom common to both heart disease and pregnancy.
Breathing can become more difficult during pregnancy as levels of progesterone increase.
By the third trimester, the diaphragm and lungs and pressed by the expanding uterus, which makes it harder to take deep breaths.
Shortness of breath is one of the most common symptoms of heart problems as well.
There May Be Many Signs of Heart Disease While Pregnant
There are many signs women can watch for during pregnancy and postpartum that may indicate heart problems.
While many of these symptoms are also common in pregnancy, they may be a sign of something serious if they are severe or do not go away with over-the-counter medication.
- Extreme fatigue
- Fainting. This symptom is also common in normal pregnancy and may be caused by blood volume and pressure changes during pregnancy.
- Persistent cough
- Extreme swelling
- Chest pain
- Severe shortness of breath, especially at rest or while lying down
- Heart palpitations, or the awareness of our heartbeat. This may be caused by the diaphragm shifting upward in the chest during pregnancy which causes the heart to sit higher, but it’s more likely to be serious when it occurs during rest, according to Northwestern Medicine.
Women With Heart Problems Can Usually Give Birth Safely
Most cases of heart disease during pregnancy are pre-existing rather than triggered by pregnancy.
For women with existing heart problems, there’s the good news: in most cases, women with heart problems like a heart valve disorder can safely carry and give birth to a child without an impact on their heart health.
The key to a healthy pregnancy with heart disease is ensuring the disorder is treated effectively.
Women with some types of heart disorders are at significant risk of issues during pregnancy, according to Merck. Disorders with an increased risk of death and complications include:
- Heart damage or cardiomyopathy from a previous pregnancy
- Some birth defects like Eisenmenger syndrome
- Pulmonary hypertension or high blood pressure in the lungs’ arteries
- Extreme aortic stenosis, or narrowing of the opening of the aortic valve