- Yes, you can have a pregnancy-related heart attack.
- Monitoring your blood pressure is a key heart-health factor with pregnancy.
- You may be eating for two, but you also need to be eating for heart health.
With all the appropriate focus on the health of your baby while you’re pregnant, it may never have occurred to you to consider your own cardiovascular health. In fact, this is a medical issue that you want to make sure you and your health care team don’t overlook.
In the United States, high blood pressure (hypertension) affects 1 of every 12 to 17 pregnancies among women ages 20 to 44. Breaking this average down to subgroups, hypertension affects pregnancies at much higher rates in African American women and in women at the older end of the maternal age range. The repercussions for the babies and moms can be serious.
Women experience an increased risk of blood clots during pregnancy and up to three months after giving birth. Pregnant women are five times more likely to experience a blood clot than are women who are not pregnant. This increased risk may be due to a number of factors, including hormonal changes, which can make the blood “stickier.” In addition, women may be less active during late pregnancy and after delivery — and pressure of the growing uterus on the veins in the pelvis can slow blood flow from the legs and abdomen, making it more likely to clot. Blood clots typically develop in the leg, thigh, pelvis or arm, but may become life-threatening if they break off and travel to the lungs, causing a condition called pulmonary embolism.
Heart attack can also occur during pregnancy or shortly after birth. Though fortunately, the risk is low. Heart attacks occur in 1 out of every 12,400 women who are in the hospital to give birth or during the six weeks after giving birth, according to a study published in Mayo Clinic Proceedings. However, heart attacks are happening to pregnant women more frequently than in the past. Researchers suspect the increase in incidence may be related to older maternal age as well as to the increasing incidence of obesity, type 2 diabetes, pre-pregnancy hypertension and elevated cholesterol.
The risks of pregnancy-related heart issues are even greater for Black women. WomenHeart, an advocacy organization for equity in women’s heart health, points out that, “Black women … suffer from life-threatening pregnancy complications twice as often as White women. And, all-too-often, those complications are related to heart disease, a leading cause of death in pregnant and postpartum women.”
To help you make sure your heart health is optimal before, during and after you give birth, here’s a look at pregnancy related cardiovascular issues, and how to prevent and manage them.
Those who have hypertension before pregnancy, develop it before the 20th week, or have it in the last trimester as a symptom of preeclampsia — a pregnancy complication involving hypertension that can damage your liver, kidneys or other organ systems — may be at risk of serious health repercussions. And that risk extends to the baby.
In addition, after women give birth, both the moms and their children may go on to develop health problems — even if the hypertension goes away. For example:
- Women with any pregnancy-related, high blood pressure disorders are at increased risk of heart and blood vessel problems down the road. The first year after giving birth is a critical time to monitor your heart health and adopt heart-healthy habits for a lifetime.
- Newborns whose moms were hypertensive may have respiratory disorders or changes in the heart structure and function that are noticeable in the months after birth.
If you have high blood pressure during pregnancy, make sure it is included on all your medical records, advises Sharonne N. Hayes, M.D., a Mayo Clinic expert on cardiovascular disease and prevention, with a focus on conditions that uniquely or predominantly affect women. “That may affect how intensely you are treated for hypertension in the future, even if it disappears after you give birth and then reappears later in life — and that can change the impact it has on your long-term health.”
Ongoing (chronic) hypertension
If you are planning to become pregnant, have your blood pressure checked. If it is elevated, work to lower it before becoming pregnant. Try lifestyle changes such as weight loss, improved nutrition and regular exercise. If that’s not enough, you may need to take medication to get your blood pressure under control.
If you have high blood pressure that’s being treated with medication, make sure to discuss the safety and appropriateness of your medication during pregnancy prior to trying to get pregnant. Some medications that help control blood pressure — such as angiotensin-converting enzyme (ACE) inhibitors — are not safe to take while you are pregnant, but there are many other safe options for you and your baby. If you have hypertension before you become pregnant — or you develop hypertension during the first 20 weeks of pregnancy — there’s a chance that you and your baby will not experience any further problems related to the hypertension, and the hypertension may go away after you give birth. However, any hypertension occurring while you are pregnant needs to be closely monitored, as complications can occur. For example, hypertension during pregnancy makes it more likely that you’ll develop gestational diabetes or need a C-section. In addition, you’re at increased risk of preeclampsia. Somewhere between 13% and 40% of pregnant women with chronic hypertension develop preeclampsia.
This form of pregnancy-related hypertension affects about 3 in every 50 pregnant women and occurs during the second half of pregnancy. It’s not necessarily harmful, but close monitoring is important, as some women do go on to develop severe hypertension and preeclampsia.
“Blood pressure is supposed to go down, not up, during pregnancy,” says Dr. Hayes, “but hypertension during pregnancy can happen to some women.”
Once hypertension is identified, the goal of treatment is to prevent blood pressure from rising further. High blood pressure can cause problems with blood flow to the placenta, which can restrict fetal growth and perhaps make an early birth necessary.
Your health care provider will monitor your blood pressure regularly, and you may need to modify your diet and get regular physical activity.
Generally, blood pressure-lowering medications are not initiated during pregnancy until the top number of your blood pressure reading (systolic pressure) is at or above 160 or the bottom number (diastolic) is at or above 105, but this guidance must be individualized and a medication is sometimes started earlier.
In addition, prenatal vitamins are always recommended. They can help you and your baby stay healthy and avoid birth defects. Recent research suggests that the folic acid and calcium in prenatal vitamin formulas also lower the risk of gestational hypertension. Ask your health care provider to clarify what doses are safe and effective for you.
Preeclampsia involves elevated blood pressure — sometimes very elevated — along with increased levels of protein in the urine and possible damage to the liver, kidneys or other organ systems. Preeclampsia can cause the placenta to separate from the wall of the uterus and contribute to low birth weight, which is defined as 5 pounds, 8 ounces (2.49 kg) or less. It usually appears after the 20th week of pregnancy and affects about 1 in 25 pregnancies in the United States. Some women with preeclampsia can develop seizures. This is called eclampsia, which is a medical emergency.
While some women have no signs of preeclampsia — which is, in part, why prenatal checkups are so important — the symptoms may include:
- A persistent headache
- Blurry vision, seeing spots or changes in eyesight
- Pain in the upper stomach area
- Nausea or vomiting
- Swelling of the face or hands
- Sudden weight gain
- Trouble breathing
It is not known why some women develop preeclampsia and others don’t. There is no way to cure or fully reverse preeclampsia but it usually resolves after delivery. Your health care team will monitor you closely to make timely decisions to keep you and your baby safe and to help determine an appropriate delivery date.
Rarely, preeclampsia develops after birth — usually within 48 hours. But it can appear up to six weeks after birth. The symptoms for postpartum preeclampsia are similar to those for preeclampsia. If you have any symptoms, call for emergency medical help right away.
If you are diagnosed with hypertension before or during your pregnancy, make sure that your blood pressure is monitored regularly and carefully — at every prenatal exam and at home with a blood pressure monitor that you use daily. If your blood pressure is increasing, notify your health care provider immediately.
You also want to adopt a healthy diet that emphasizes:
- Minimally processed plant foods, such as whole grains, vegetables, fruit, unsalted nuts, beans and other legumes, seeds, and herbs and spices
- Healthy fat sources, such as olive oil
- Lean protein sources, such as lean meats, poultry and fish, and low-fat dairy
All of these food sources are naturally low in sodium. Excess sodium can contribute to elevated blood pressure. The Dietary Approaches to Stop Hypertension (DASH) diet is commonly recommended to help reduce elevated blood pressure. In contrast, restaurant food, convenience foods and more heavily processed foods are often very high in sodium.
For more information to help you and your baby thrive, check out “The Mayo Clinic Guide to a Healthy Pregnancy.” It’s a comprehensive guide to all aspects of pregnancy and delivery, including issues related to hypertension — and healthy eating.
Cecily Foster’s story — A serious heart problem after delivery, with little warning
“In my eight month, I went into my doctor’s office for my weekly visit, and they noticed my amniotic fluid was very low. That meant that I had to give birth four weeks early. Luckily, it all went well. Or so I thought. But one day not long after my baby and I went home, I noticed a pain in my chest. I called my doctor and she said get to the emergency room immediately. I was diagnosed with postpartum cardiomyopathy, a rare condition that causes heart failure.
“There had been nothing that indicated that something wrong was going on, no signs or symptoms of heart problems or a heart attack,” said Foster.
Since then, Foster has become a WomenHeart Champion and has been working as a WomenHeart Support Coordinator. “I don’t want anyone to feel like she is alone and she has to go through both the physical and mental rehabilitation by herself.”
It’s not known why postpartum cardiomyopathy develops. But it may be a result of a previous viral illness or a misdirected immune response, a heart spasm, genetics, or damage to the small arteries of the heart. The recognized risk factors are being over the age of 30, being African American and being pregnant with multiples. Only about 1,000 to 1,300 women a year are diagnosed with the condition.”
Sharonne N. Hayes, M.D.
Dr. Hayes is a cardiologist and Professor of Cardiovascular Medicine at Mayo Clinic. She has over 25 years of experience in treating complex heart and blood vessel conditions, especially those that uniquely or disproportionately affect women. She founded and practices in the Women’s Heart Clinic and has diverse research interests that include sex and gender-based cardiology, spontaneous coronary artery dissection (SCAD), health equity, and the utility and optimal role of social media in clinical practice, medical research and health education.