Scott Webb: Some women who go through pregnancy may be at increased risk
during and after pregnancy for heart or cardiovascular issues,
and my guest today is here to explain the risks and conditions.
I'm joined today by Dr.
Steven Cook.
He's a board-certified cardiologist, subspecializing in noninvasive
cardiology at Franciscanhealth.org.
Scott Webb (Host): This is the Franciscan Health Doc Pod.
I'm Scott Webb.
Scott Webb: Doctor, so nice to have you here today.
We're gonna talk about pregnancy And the heart, right?
And some of the conditions, that women might be experiencing or be concerned
about, whether it's, you know, things that they've been diagnosed with, or
family history, whatever it might be.
So, I'm just gonna kind of give you a little bit of a list here and have you
go through and kind of explain what these things are and how they might affect your
pregnancy And the heart, if you will.
So let's start with preeclampsia, gestational diabetes.
Peripartum cardiomyopathy.
Some big words here and I'll leave it to you, the expert.
Dr. Stephen Cook:
So these terms are incredibly important to recognize today.
These are terms that we didn't really give much thought maybe several years ago.
They're kind of maybe considered under an umbrella term now and
adverse pregnancy outcomes.
And, you know, I would actually kind of group preeclampsia
under what we now classify as hypertensive disorders of pregnancy.
Gestational diabetes and preterm birth.
These are all thought of today as adverse pregnancy outcomes.
And why is this so important for a cardiologist to recognize?
Well, these are now all what I call sex specific risk factors for
cardiovascular disease in women.
And these are all independent risk factors that are associated with what we
call ischemic disease or cardiovascular.
Disease later in life for women.
So for example, what we call hypertensive disorders of pregnancy,,
which includes preeclampsia, and I'll go over what that definition means.
So for hypertensive disorders of pregnancy, This is associated
with a two to four times.
Increased risk of cardiovascular disease in women later in
life and by later in life.
If you're a 20-year-old woman by age 40 or 50, this means that you have
a two to four times more likelihood of having a heart attack or stroke.
Compared to women who don't have hypertension in their pregnancy, these
women are also three to six times more likely to have chronic hypertension.
Should they have evidence of preeclampsia during their pregnancy or even just
hypertension during their pregnancy?
And these women are two times more likely of having an ischemic
stroke compared to women without hypertension during their pregnancy.
So let's talk about the spectrum of what hypertensive disorders of pregnancy means.
So these are women that just have a history of hypertension.
That then, you know, continues on during their pregnancy, or perhaps women that
develop hypertension before 20 weeks.
And then you can have what's called gestational hypertension.
This is hypertension that's developed after 20 weeks of pregnancy, And then
preeclampsia is a little bit more severe.
This is hypertension that develops.
After 20 weeks fetal gestational age, or that's also associated
with spilling protein in the urine.
You can also develop some end organ dysfunction or kidney dysfunction as
well, so it's a little bit more severe.
Hypertension during pregnancy.
I also mentioned gestational diabetes, so for these women who
develop diabetes during pregnancy.
They're two times more likely to develop heart disease.
So heart attacks and stroke, compared to those women who do not develop,
diabetes during their pregnancy.
So for women who don't go on to progress type two diabetes after
their pregnancy, it doesn't matter.
These women are much more likely to develop heart disease if they
have a history of gestational diabetes during their pregnancy.
And lastly, it's important to recognize preterm birth, though these are
women who, deliver before 37 weeks.
These women are also two times more likely to develop heart disease compared to,
women who did not have a preterm delivery.
So it's so important to recognize and to take this history as a
cardiologist today because, You know, what are the clinical implications?
Well, You know, I typically will see women in the fourth trimester
and start to be more aggressive with my postpartum screening.
I definitely am more strict about blood pressure control postpartum.
I'm more strict about getting cholesterol panels, and most
important is empowering the patient.
Really providing patient education post delivery in that fourth
trimester visit about diet, exercise, and weight management.
Scott Webb: Yeah.
Yeah.
I have a couple of kids myself, of course, and You know, my wife carried
our children, thankfully she did the heavy lifting, if you will, but it's,
You know, hard enough to be carrying another human being around, or maybe
multiple human beings inside your body, And then have to think about all of
this, which may or may not affect someone during pregnancy, but as you're saying.
May after pregnancy, after they give birth or years down the line.
So it's a lot to think about.
It makes me think, doctor, that maybe that pregnancy is kind of a,
a great stress test for the heart.
That's what it sounds like to me.
And maybe you could explain that.
Dr. Stephen Cook:
Yeah, a lot of people refer to pregnancy as a stress test, and it's commonly
referred to this because of the incredible physiologic adaptations,
that occur during pregnancy.
When I think about the cardiovascular system, And what do I mean by that?
So when I'm referring to the cardiovascular system, I'm talking
about the heart And the blood vessels.
So.
For women, the blood volume increases significantly during pregnancy, And this
increase starts in the first trimester, about six weeks, And the blood volume
reaches a maximum volume of about 4.7
to five liters by 32 weeks, or by the third trimester.
When you think about what is five liters, that's roughly the
weight of 11 pounds of water.
And that rapid increase is typically noted by mid-pregnancy.
Now, that to me, is a significant, uh, would be a significant stress
test, especially if somebody had underlying heart disease, right?
The heart rate also increases.
The maximum increases anywhere from about 15 to 20 beats per minute.
Again, This is happening by about 32 weeks per, 32 weeks gestation.
And why does all this water retention occur?
Well, there's a lot of hormone changes, right?
Estrogen itself promotes the retention of sodium during pregnancy, And this
increases our overall total body water content and creates this, what
I call hypervolemia during pregnancy.
So these types of changes will be poorly tolerated in women with
heart disease And the most common.
Poor outcomes that we see.
It is heart failure and arrhythmias.
These are the most common complications that we'll see
in women with heart disease.
And alternatively, if you have a woman who has heart disease, but it is unknown,
it'll easily be unveiled during pregnancy.
, I know you mentioned this earlier, we can talk about this.
Probably one of the most common conditions that we see unveiled is a condition
known as peripartum cardiomyopathy.
I think it's important to recognize that it is, how do we assess pregnancy risk?
Because cardiovascular disease affects one in seven pregnancies, So, It is
incredibly important that women with heart disease can certainly benefit from
preconception counseling, which really starts, , in not only the obstetrical
office, but also the cardiology office.
You know, we can easily have a detailed discussion of the risks of pregnancy.
Many women who have heart disease may require optimization
of their heart status.
If there are certain medications that are not safe for the
baby to see during pregnancy.
So it's up to me, the cardiologist to either stop that medication
or switch to safer medications.
Um..
It's important to do what I call risk stratification, even doing a
simple EKG, or perhaps they need what's called an ultrasound or
an echocardiogram to look at the structure or the function of the heart.
, These are so many important things to do.
As you can see that those physiologic changes can certainly
have, some significant outcomes on women during their pregnancies.
Scott Webb: Yeah, and I wanted to finish up today, doctor, I know
we're gonna talk again in the near future about women equity, access
to care, really important stuff.
But let's finish up today.
You touched on it there, and it kind of struck a chord for me how
obstetricians and cardiologists.
Work together should work together, can collaborate together,
for prevention of some of the things we're talking about here.
Dr. Stephen Cook:
Yeah, I, I think it's important to recognize that one of the key
facets to successful care for.
Women with cardiovascular disease who are pursuing pregnancy is really a
multidisciplinary approach to care, right?
We know that cardio obstetrics clinics have actually been shown to
decrease adverse heart complications for women with pregnancy.
Members of teams of cardio obstetrics teams, if you hear the term cardio
obstetrics, you think, oh, it's just a cardiologist and an obstetrician.
Many times that's not true.
If you have somebody with heart failure, perhaps they need to see an
advanced heart failure specialist.
If they have heart rhythm problems, perhaps they need to
also see an electrophysiologist.
Sometimes if they have severe valvular heart disease, perhaps do
they need to see a cardiac surgeon?
You know, it's also pulling in the nursing care to make sure that they understand
the plan of care at the time of delivery.
So, it is.
Certainly a real multidisciplinary team to really get these patient's
all the way through their pregnancy, delivery, and postpartum care.
You know, probably one of the most important aspects of this team
care from an operational standpoint is the importance of regular
multidisciplinary meetings to really facilitate patient centered decisions.
About their testing, how to manage their disease, and to ideally is
to coordinate their delivery plans.
And by having this team-based approach, I really believe that
we can improve patient outcomes.
Scott Webb: Yeah, I'm sure you're right.
and that's just, you know, music to my EARS, if you will.
It seems to be the way in medicine now is, more a team approach.
Multidisciplinary teams working together, patient centered, working
with patient's and spouses and families and everybody for the best outcomes.
all sounds great to me.
Like I said, we're gonna speak again in the future, talk about
women equity, access to care, and how we can do better if you will.
Thanks so much.
Dr. Stephen Cook:
Thank you.
Scott Webb: And to learn more, visit franciscanhealth.org
dot org slash her heart.
Host: And if you found this podcast helpful, please share it on your
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This is the Franciscan Health Doc Pod.
I'm Scott Webb.
Stay well, and we'll talk again next time.