OH BABY! Heart Disease & Maternal Deaths

As many of you already know, my heart disease journey started when I was pregnant with my baby girl. As a matter of fact, I had rheumatic heart disease before I was pregnant but I did not know. My story is not unique. Many women die each year during (or shortly after) pregnancy due to heart disease related complications or misdiagnosis. In fact, similarly to what happened to me, many women are unaware that they have heart disease until they become pregnant if they are lucky. Sadly, many seemingly healthy young women die during or after childbirth as a result of undiagnosed heart disease.

Heart disease is a leading cause of indirect maternal death in developing countries as well as developed countries. Cardiovascular disease is cited as a major cause of pregnancy related maternal mortality. In western countries, major causes of death from heart disease include myocardial infarction, cardiomyopathy and congenital heart disease. However in developing countries, rheumatic heart disease remains a major cause of maternal heart disease related deaths. I was born and raised in Jamaica (a developing country) and unbeknownst to me I acquired rheumatic heart disease resulting from untreated strep throat as a child. I was fortunate because I became pregnant and had my daughter in the United States, however, I am aware of the fact that I would have probably died if I was living in Jamaica at the time of my pregnancy and traumatic delivery.

My pregnancy and post-partum recovery was definitely complicated but I was not alone. Maternal heart disease complicates 1 to 4 % of pregnancies. Studies have shown that majority of maternal deaths have occurred in women with previously undiagnosed heart diseases, which if you think about it, the most joyous experience of giving birth can quickly become deadly.

Why Does It Happen?

Hemodynamic changes occur during pregnancy to meet the demands of a woman’s changing body. Blood volume increases as much as 40-50% during pregnancy. It results in increased heart rate (15 beats per minute more than normal), stroke volume, and cardiac output. These changes cause a woman’s heart to work harder than ever before and this burden of pregnancy can reveal undiagnosed heart conditions. Very often women with rheumatic heart disease are diagnosed for the first time during pregnancy because the increase in blood volume and heart rate caused symptoms that did not occur before pregnancy. This was exactly what happened to me. I was seemingly healthy before pregnancy, went into heart failure as a result of undiagnosed rheumatic heart disease, and suffered respiratory distress two days after giving birth. Luckily, I was still in the hospital when this happened and was able to get lifesaving interventions.

Risk Factors

Risk factors for heart disease in pregnancy include:
• Family history of cardiac disease
• Hypertension
• Obesity
• Age
The growing prevalence of diabetes, hypertension and obesity has increased the number of pregnant women with acquired heart diseases. There are two major reasons for that:
• Women with congenital heart disease are surviving to reproductive age due to better health care.
• More women are now opting to have kids in their 30s.
Because of the advancement in the field of medicine most women with heart diseases can now safely give birth to healthy children without compromising their heart function and life span. Women who have already been diagnosed with serious heart conditions are at a greater risk of complications. Risk assessment is mandatory for women with heart diseases and management of pregnancy and delivery should be planned accordingly.

How to Improve Your Chances?

Many women with heart conditions can have a healthy pregnancy. These include but are not limited to heart murmur, arrhythmia and other acquired heart conditions. That’s promising news, however, there are few conditions in which doctors suggest that pregnancy should not be attempted as they put the mother at severe risk. These include Marfan syndrome, pulmonary hypertension, severe heart valve disease and history of heart attack to name a few. If a woman who has been diagnosed with these conditions gets pregnant, doctors may advise her to terminate the pregnancy as soon as possible.

The risk of heart disease related problems increases throughout pregnancy as stress on heart increases in the third trimester. Pregnant women with heart disease may become unusually tired and are suggested to limit their activities. Doctors advise pregnant women to get enough rest, schedule frequent checkups, avoid gaining excess weight, and avoid stress. After delivery, a pregnant woman may not be out of danger for six months or more depending on the type of heart disease. Patient should be monitored closely and checked periodically for several weeks by a cardiologist.
Although pregnant women with heart diseases will still face some issues, there are ways that can minimize the risk of such diseases, on the mother and the child. It is suggested that at risk women consult with their healthcare team for a risk assessment preferably before they conceive or soon after they conceive. Regular check-up will ensure that even if some complication arises, it can be dealt with accordingly.

I must say that I am still traumatized by my pregnancy experience and the heart disease complications I had and I am not sure if I will have another child. Only time and my medical team will tell.

Do you have heart disease and are considering pregnancy? Do you have a pregnancy story? I would love to hear from you.