Pregnancy Health and Heart Disease
As if being on bedrest or having grotesquely swollen ankles during pregnancy wasn’t already stressful enough, doctors are now reevaluating problem pregnancies as a signal to future health concerns, particularly heart disease. Preeclampsia (high blood pressure during pregnancy) and gestational diabetes (high blood sugar during pregnancy) were already identified in some studies a few years ago as possible precursors to later heart disease in women; the American Heart Association took it one step further last month, now identifying these complications as a "stress test for the heart” that primary care physicians should take into account when evaluating their patients.
"There are things that happen as to how blood vessels respond to those conditions,” says Dr. Elizabeth Ofili, chief of cardiology at Morehouse School of Medicine in Atlanta, "leaving lasting residual risk that may lead to future damage.”
The AHA’s recommendation is significant because it acknowledges that a woman’s obstetrician may have important information that her primary care physician does not — in fact, Dr. Ofili notes that many women are more likely to schedule appointments with their OB-GYN on a regular basis, often twice a year, putting the OB-GYN into a role of a general practitioner. "Some OB-GYNs are getting more attentive to this
relationship between difficult pregnancies and future heart disease risk,” says Dr. Ofili, but she recommends that women remember to schedule annual visits with their primary care providers. "Primary care physicians need to be aware of this type of history in their patients and those women should be plugged into an adult preventive cardiology program.”
However, it is possible to try to head off these complications in the first place. If there is a family history of preeclampsia or gestational diabetes, women should consult with their OB-GYN, who will closely monitor blood pressure or blood sugar. Pre-pregnancy weight is a significant factor: "Women should try to be at a healthy weight before they get pregnant,” advises Dr. Ofili, "and, then, once they become pregnant, try to gain weight at a healthy rate, which can help prevent any serious complications.”
As to how these complications can affect the baby, data shows that there is a significant relationship between a mother with gestational diabetes and the likelihood that her baby will be diabetic. There is less direct association between preeclampsia in the mother and high blood pressure in her child, but the risk of other complications, such as kidney disease, is increased. Says Dr. Ofili, "Start early with preventive care and then keep your primary care physician alerted to any changes in your health.”