Pregnant or TTC? New research shows just how important heart health is

A recent report in Circulation finds that, well, there’s some room for improvement.

Researchers say “optimal” pre-pregnancy heart health went down more than 3% between 2016 and 2019. They define optimal heart health in women as being without hypertension or diabetes and having a body mass index (BMI) between 18 to 24.9 kg/m²—that’s the “healthy weight” category according to the U.S. Centers for Disease Control and Prevention (CDC). While BMI is not considered by many experts to be an accurate health marker, it is often used in a clinical setting and in clinical studies as one metric of overall health. 

The team evaluated CDC data on pre-pregnancy heart health risks of 14,174,625 women who had children. The women were between 20 and 44 years old; 81.4% were between the ages of 20 to 34.

Why is pre-pregnancy heart health declining? The scientists say being in the CDC’s overweight or obese categories is a leading driver, with hypertension and diabetes following.  

(The CDC defines the terms “overweight” and “obese” based on our body mass index, or BMI. Here is their breakdown of numbers.)

“Pregnancy is nature’s stress test.”

From 2016 to 2019, the researchers say 37.1% of women between 40 and 44 had good heart health—in women between 30 and 34 years old, 42.2% had good heart health.

Heart disease causes more than one in four pregnancy-related deaths, according to the American Heart Association’s Heart Disease and Stroke Statistics 2022 Update.

“Pregnancy is nature’s stress test. There are many changes in the body during pregnancy, particularly the heart, including increased blood circulation that put an extra burden on a woman’s heart,” says Garima V. Sharma, MD, director of cardio-obstetrics and an assistant professor of medicine at Johns Hopkins School of Medicine, in a statement. Dr. Sharma was not involved in the study, but co-authored an American Heart Association report on cardiovascular considerations for pregnant patients.

Heart health and fertility treatments

A recent study in the Journal of the American Heart Association reports that women using fertility treatments may be at a higher risk for having or developing conditions like chronic high blood pressure—especially if they’re over 35.

The study looked at 106,000 deliveries as a result of assisted reproductive technology (ART) and compared them to more than 34 million births conceived without infertility treatments.

Women who used treatments to get pregnant had a 2.5 times higher risk of acute kidney failure and a 65% higher risk for irregular heartbeat. They had a 57% higher risk for placental abruption (that’s when the placenta separates from the uterine wall). The women were also 38% more likely to need a C-section, and 26% more likely to have premature births.

Pensée Wu, MD, an author of the study and a senior lecturer and honorary consultant obstetrician and subspecialist in maternal fetal medicine at Keele University School of Medicine in Staffordshire, UK, tells Motherly that it’s “difficult to know why the association exists.”

“We had accounted for cardiovascular risk factors and the associations were still there,” she says, citing risk factors such as age and smoking status. Her team also looked at whether the women had high blood pressure, congenital heart disease, heart failure, previous heart attacks and strokes, and heart valve disease.

Some pregnancy complications have been linked to getting heart disease in later life, such as preterm birth and preeclampsia, Dr. Wu notes.

“Women who have had preeclampsia have double the risk of developing high blood pressure, stroke and heart disease, as well as quadruple the risk of heart failure in the future, compared to women who did not have preeclampsia,” Dr. Wu says.

Here’s something to note about Dr. Wu’s research: It found that women who used fertility treatments on the whole had more pre-existing health conditions like diabetes and high blood pressure. They were also more likely to be defined clinically as obese when starting treatments.

The study showed a link but doesn’t say that fertility treatments cause the ailments, and it didn’t explore underlying mechanisms, Dr. Wu stresses.

How you can improve heart health

Knowing all this, what can you do to improve your heart health before, during and after pregnancy?

Keep up with your physicals. Get hypertension, diabetes, and high cholesterol under control before becoming pregnant if possible, Dr. Sharma says. The healthier a woman is before, during and after pregnancy can yield the best results for mothers and babies, Dr. Sharma explains.

Aim for a health-focused lifestyle. Eating a balanced diet that’s rich in plant foods, staying active, and not smoking can improve heart health, Dr. Wu adds.

“Because of their increased risk to heart health, a healthy lifestyle is even more important for women trying to conceive using assisted reproductive technology,” she notes.

Sources

Cameron NA, Freaney PM, Wang MC, Perak AM, Dolan BM, O’Brien MJ, Tandon SD, Davis MM, Grobman WA, Allen NB, Greenland P. Geographic Differences in Prepregnancy Cardiometabolic Health in the United States, 2016 Through 2019. Circulation. 2022 Feb 15;145(7):549-51. doi:10.1161/CIRCULATIONAHA.121.057107

Wu P, Sharma GV, Mehta LS, Chew‐Graham CA, Lundberg GP, Nerenberg KA, Graham MM, Chappell LC, Kadam UT, Jordan KP, Mamas MA. In‐Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology. Journal of the American Heart Association. 2021 Dec 9:e022658. doi:10.1161/JAHA.121.022658