The rate of heart attacks among patients under 40 – the same age group most likely to become pregnant – is on the rise in the U.S.
Two troubling trends are prompting health care providers to monitor pregnant patients for heart disease risk more closely:
- Approximately half of pregnancy-associated heart attacks are in the postpartum period, when a woman’s heart is still working harder to pump excess blood but the focus has shifted to her newborn’s health. More than 75% of pregnancy-associated heart attacks are in women 30 and older.
- Heart disease has become the leading cause of death during and after pregnancy. Data shows that black women have a higher risk of dying from cardiovascular disease during pregnancy than white and Hispanic women.
When a woman is pregnant, her blood volume can increase by 45%, stressing the heart’s workload as it pumps extra blood to sustain the baby’s growth. This internal effect of pregnancy is less noticeable than external changes, but it can contribute to more serious complications – especially in women who have had a previous heart attack.
A heart attack occurs when the buildup of plaque (a combination of cholesterol and fat in the blood) is so large it completely blocks blood flow to the coronary arteries, which supply the heart with blood. Coronary artery disease (CAD) is the most common type of heart disease, and when the heart is strained by CAD and pregnancy, the risk of heart attack increases.
Unfortunately, someone living with heart disease might not know it until they have a heart attack. Or they may develop high blood pressure or diabetes during pregnancy, which increases their risk of a heart attack. So does a preterm delivery, an underweight baby, or pregnancy loss, according to the American Heart Association (AHA).
Discuss your heart health background with your doctor. If you are at risk of developing heart disease complications, we will take extra precautions.
Related reading: Erica's pregnancy story: Heart attack at 31, baby at 36
Preventing heart attacks during and after pregnancy
Lifestyle changes, such as exercising regularly and eating more heart-healthy foods, are one of the most effective ways to prevent heart attacks.
More plants, less salt
I often recommend two eating plans to help patients reduce their risk of heart disease. Both options help reduce cholesterol that builds up in the arteries. Work with your cardiologist and Ob/Gyn to determine the best foods to add to your diet:
- The Mediterranean diet limits red meat and sweets, and focuses on eating more fruits, vegetables, beans, nuts, and seeds, along with grains, potatoes, and some fish and poultry. It recommends olive oil as the main source of fat instead of butter and other dairy products. Several studies have shown that the nutrients within these food groups improve cardiovascular health.
- The Dietary Approaches to Stop Hypertension (DASH) eating plan was designed to reduce blood pressure by limiting salt along with red meat and added sugars. It recommends the same food groups as the Mediterranean diet but incorporates more dairy and lean protein.
Some types of fish are not recommended during pregnancy, and you might develop an aversion to certain foods. A nutritionist can help you swap heart-healthy options for foods you can’t have – or don’t want to eat.
Related reading: Eating for two? How to maintain a healthy weight during pregnancy
The AHA recommends at least 150 minutes of physical activity a week to improve blood flow, lower cholesterol, control blood sugar, and reduce overall stress on your heart. Pregnancy isn’t the time to start an intense fitness program, but if you worked out regularly before becoming pregnant, it’s perfectly safe – and highly recommended – to continue many of your favorite activities.
If you didn’t work out before, it’s important to exercise once you’re pregnant. Walking 30 minutes a day is a great place to start. Swimming and riding a stationary bike are also popular among pregnant patients, along with yoga, which provides psychological benefits as well. Discuss your ongoing fitness level with your health care providers to ensure you’re choosing movement that will help strengthen your heart and not overstimulate it.
Countering high cholesterol with medication
Women's cholesterol levels rise during pregnancy to create functional hormones. They can increase even higher in patients with familial hypercholesterolemia, a genetic condition that causes high cholesterol.
Taking statins, a class of medications that can lower cholesterol and reduce heart attack risk, is not recommended in the months leading up to, during, and following pregnancy because of the potential risk of pregnancy loss. Talk to your doctor about other possible medications that are safe during pregnancy.
Collaboration improves prevention
At UT Southwestern, Ob/Gyns partner with cardiologists and other specialists to ensure patients with or at risk of heart disease receive personalized care before, during, and after they give birth.
To bring heart disease rates back down, we need more open conversations about risk factors as well as healthy eating and exercise habits. You can make the necessary choices to support a healthy pregnancy, and we’ll be here to guide and provide the best treatments possible.