In April, I had the pleasure of attending the American Congress of Obstetricians and Gynecologists (ACOG) national meeting in Austin. A major theme was a topic that has increased in importance the past few years: For many women, prenatal care is the gateway to lifelong health care. Prior to pregnancy, many women don’t see their doctors regularly, missing out on care that could affect their health for years down the road.
It was a pleasure to see so many UT Southwestern doctors addressing this topic and other important issues at the ACOG meeting. First, Lisa Hollier, M.D., a former fellow and faculty colleague from UT Southwestern, was inducted as the 69th President of ACOG. Additionally, Mary Walsh, M.D., who did her internal medicine training at UT Southwestern and is the immediate-Past President of the American College of Cardiology, gave a particularly exciting presentation on the platform of lifelong health.
Dr. Walsh began her presentation with an all-too familiar scenario: the story of a premature delivery for preeclampsia, or hypertension that develops during pregnancy. Delivery is the “cure” for preeclampsia, and once the baby is delivered, doctors naturally focus on the baby’s short- and long-term outcomes: lung function, brain health, feeding, and future cognitive development.
But we haven’t been particularly good at thinking about the mother’s long-term outcomes following pregnancy-related health conditions. Though we think of pregnancy as a normal stressor on the body, this presentation was a wake-up call that we must think about how pregnancy affects women’s health down the road. As such, we should think about pregnancy as a kind of “stress test” for long-term heart health rather than simply a standalone condition.
How pregnancy can stress the heart
In normal pregnancies, blood volume increases by 50 percent, the heart rate goes up, and the heart has to work harder. These are all expected changes during pregnancy; however, these changes do place additional stress on the heart. Therefore, we must recognize that the way a woman’s body functions during the “stress test” of pregnancy likely has implications for her future health. What we need to determine is the extent of the changes and how we follow patients after postpartum care has ended.
For example, we know that women who have any type of high blood pressure during pregnancy are at increased risk of future cardiovascular disease, diabetes, and chronic kidney disease. When women who had preeclampsia during pregnancy are examined 15 years after that delivery, they are nearly four times as likely to have developed chronic hypertension and twice as likely to be diagnosed with ischemic cardiac disease than women who didn’t have preeclampsia, according to data from a 2015 study.
Another heart condition that is diagnosed with pregnancy is peripartum cardiomyopathy – heart failure that develops anytime from the last few weeks of pregnancy to a few months postpartum. Previously, some doctors felt the pregnancy actually caused the condition, but today more doctors are considering the possibility that the condition was already there and pregnancy simply unmasked it.
How this mindset shift will affect our patients’ care
Fortunately, many of our patients see us over the entirety of their pregnancies. As such, we’re often able to diagnose existing pregnancy-related conditions early and adjust their care appropriately. However, once their postpartum care concludes, we need to do a better job of encouraging continued care to protect our patients’ health.
As such, we’re kicking off an initiative to create plans of follow-up care that are reliable and actionable after women move on from postpartum care, including more frequent checkups in the six weeks after delivery and more streamlined care recommendations. Ob/Gyns have an important role in screening for other health issues, such as diabetes, heart disease, and depression as their patients age. For example, if we know a woman had preeclampsia during a previous pregnancy, we will check more frequently for blood pressure concerns and recommend that she visit her primary care doctor after pregnancy to be checked regularly for hypertension.
Equally as important, doctors must pay attention to women’s pregnancy-related health history in all aspects of their health. Doctors today are responsible for whole-patient wellness, not just the treatment of diseases. Particularly in women’s health, we’re discovering more and more that health care must be personalized to patients’ individual needs. As this new era in obstetrics and gynecology unfurls, patients can expect care that takes their unique health histories into account more than ever. It’s our hope that this mindset shift translates into better outcomes for women over the course of their lives.