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Pregnancy is a heart stress test
The load of pregnancy
Fewer than 50 percent of women who become pregnant are at optimal heart health. Once pregnancy begins, blood volume goes up, hormones change, and heart rate and blood pressure shift. All of that puts the heart under load.
Risks that stay
Between 10 and 20 percent of women develop some form of high blood pressure during pregnancy, and that marks them as higher risk in the future. About 5 to 10 percent develop gestational diabetes, and even when it goes away after childbirth, the higher risk stays. These are called adverse pregnancy outcomes, or APOs, and they become part of a woman's heart history even if everything resolves after delivery.
Care across specialties
Most young women see only an OBGYN, so obstetricians and gynecologists have to work as partners with internists and cardiologists. The American Heart Association and the American College of Obstetricians and Gynecologists are working on that, and the training of doctors and residents has to change so they know pregnancy risks going in. Black women are more likely to develop pregnancy-related heart problems.
Why does pregnancy raise blood volume so much?
Blood volume climbs by roughly 40 to 50 percent by late pregnancy, according to the American College of Obstetricians and Gynecologists. The extra blood supplies the placenta and the growing baby, and it cushions the mother against blood loss at delivery. The heart responds by raising its output per minute by a similar share. The workload peaks in the weeks around delivery, when fluids shift rapidly.
How does preeclampsia point to later heart disease?
Preeclampsia involves damage to the lining of blood vessels, which can raise blood pressure and strain the kidneys and liver. The American Heart Association added preeclampsia to its list of cardiovascular risk factors for women in its 2011 prevention guidelines. Studies have found that women who had it face a higher chance of high blood pressure and heart disease in the decades afterward. The same vessel-lining injury may help explain the link.
Why does gestational diabetes leave a long-term mark?
Hormones made by the placenta make the body's cells less responsive to insulin, and gestational diabetes appears when the pancreas can't keep up. A 2009 meta-analysis in The Lancet by Bellamy and colleagues found that women who had it were about seven times as likely to develop type 2 diabetes later. That tells researchers the pregnancy exposed a metabolic weakness that was already there. Type 2 diabetes is itself a major driver of heart disease.
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