More and more, researchers are finding that pregnancy health and related factors in young women are connected to the future heart health of older women. The latest review of 32 studies is the most powerful evidence yet.
It is called an “umbrella study,” because it combines the results of many other review studies. Umbrella studies are considered among the highest levels of evidence available.
This new study, published in the British Medical Journal, looked at how fertility issues and pregnancy complications affect the heart later on. The studies followed women for about 7 to 10 years to see the effect of these factors on their risk for heart attacks, strokes, and heart failure over time.
Researchers found that having a premature birth, a stillborn baby, or pre-eclampsia (a serious pregnancy complication involving high blood pressure), were each associated with a 2 times greater risk for future heart problems. Having diabetes or high blood pressure during pregnancy as well as conditions such as placental abruption (when the placenta comes away from the uterus) and premature ovarian insufficiency (when the ovaries don’t work well before age 40) were also linked to a significantly higher risk for future heart problems.
When just looking at the risk for heart failure, researchers found that certain factors were linked to a 4 times greater risk for the condition. These included pre-eclampsia, diabetes during pregnancy, stillbirth, and premature birth. That’s why some researchers have called pregnancy nature’s “stress test” for the heart.
Other factors were also associated with future heart problems—but not as strongly. These included early menstruation (before age 12), early menopause (before age 45), and polycystic ovary syndrome, a hormonal disorder that causes multiple cysts on the ovaries and makes it harder to get pregnant.
It’s not possible to control all the fertility and pregnancy factors that lead to heart problems. For instance, females can’t control when their body starts menstruation or goes through menopause.
But catching problems like high blood pressure and high blood sugar during pregnancy early and keeping these conditions under control may help prevent future heart problems down the road. The study also suggests that breastfeeding for longer periods of time may reduce the risk for future heart issues.
General lifestyle steps can also make a difference. Eating a healthy diet and exercising, with a doctor’s OK, can help keep the heart strong during and after pregnancy.
Women should avoid putting on too many pounds during pregnancy. It can be hard to lose the extra weight after the baby is born, putting extra stress on the heart.
Here are the CDC’s guidelines for weight gain during pregnancy to make sure women gain the right amount for themselves and their baby. These guidelines are based on what is called body-mass index (BMI), a measure that’s calculated from a person’s weight and height.
Underweight women (BMI < 18.5) should gain 28-40 lbs.
Normal weight women (BMI 18.5-24.9) should gain 25-35 lbs.
Overweight women (BMI 25.0-29.9) should gain 15-25 lbs.
Obese women (BMI ≥ 30) should gain 11-20 lbs.
After pregnancy, women should be sure to followup with their healthcare provider to monitor major heart disease risk factors like high blood pressure and high blood sugar, and keep a healthy weight. Doctors may also consider more frequent heart screenings for patients who had problems in pregnancy. The current American Heart Association/American College of Cardiology Guideline on the Management of Blood Cholesterol instructs physicians to consider these pregnancy-related issues as Risk-Enhancing Factors and use them to help determine whether more aggressive risk-reduction strategies for prevention of heart attacks are needed.
The heart risks for women related to pregnancy are life-long. Fortunately they may also be avoidable!