Pregnancy: the ultimate cardiac stress test

by Carolyn Thomas

I’m not interested in this Canadian women’s health initiative in Kingston, Ontario just because it will help identify links between our pregnancy complications and heart disease.

I’m not interested in this just because during my first pregnancy I was diagnosed with pre-eclampsia – a serious complication that has now been “strongly linked” with a marked increase in cardiovascular disease.

And I’m not interested just because I have such a personal soft spot for the historic limestone city of Kingston and for its venerable Queen’s University, along with other members of our family who are Queen’s grads – “Oil thigh na Banrighinn! Cha-gheill! Cha-gheill! Cha-gheill! ” (for those of you who happen to have your Gaelic-English dictionaries handy).

Here’s why I do care about this innovative new women’s program.  

When I was hospitalized following my heart attack in 2008, doctors asked me if I’d ever been a smoker. They were keen to find out if  I had been treated for diabetes or high blood pressure. Did I, they wondered, perhaps have a family history of heart disease?

But I have never been asked by any physician – then or since! –  if I’d ever been diagnosed with pre-eclampsia or other pregnancy complications.

Nor was I warned, back when I was diagnosed with pre-eclampsia while pregnant with my son, Ben, that this condition is linked to a significantly higher risk of having a future heart attack some day.

In fact, most major women’s health research studies have not asked women about their pregnancy history at all.

So I am very interested in this  new health initiative in Kingston because, as a mother of two, I agree so whole-heartedly with the philosophy behind what’s known as the Mothers Health Education Research and Screening (MotHERS) program, which reminds us:

“Healthy pregnancies lead to healthy children and healthy adults. And improving a mother’s health benefits the whole family.“

And that improvement can start as soon as a woman discovers she is pregnant.

The unique MotHERS Program in Kington has been developed by husband-and-wife obstetricians and Queen’s University faculty members Dr. Graeme Smith and Dr. Susan Chamberlain. Their program is personally funded, and receives additional revenue through advertising space on their website.

Pregnancy itself is essentially a stress test.  Before reading this today, did you know that what happens to you during your pregnancy can indicate your risk of developing a future serious health problem – such as a heart attack? Most women – and their doctors – have no idea.

For example, Dr. Smith and his team at the Queen’s Perinatal Research Unit tracked 600 women after pregnancy, half of whom had been diagnosed with pre-eclampsia before giving birth. Their study*, called “A History of Pre-Eclampsia Identifies Women Who Have Underlying Cardiovascular Risk Factors”, was published in 2009 in the American Journal of Obstetrics and Gynecology.

They compared women from the pre-eclampsia group to women without the condition. They found that, compared to the control group, women in the pre-eclampsia group had these known risk factors for heart disease:

• higher blood pressure
• higher LDL (bad) cholesterol
• higher blood sugar
• higher body mass index (BMI) scores

In fact, pre-eclampsia increases the risk of heart disease by 2- to 3-fold, according to Dr. Smith and his team.

One year ago, I asked him about this landmark research, and specifically if we should now be adding pre-eclampsia and other pregnancy complications to our list of known heart disease risk factors for women. His reply:

“There are three times in a woman’s life when she is seen by a health care professional on a regular basis:

• 1. as a newborn/toddler
• 2. when (if) she develops a chronic disease
• 3. when she is pregnant

“Pregnancy is a window of opportunity to screen women for health risks to ensure health preservation and disease prevention”.

Dr. Smith also told the New York Times last year:

“Such findings are a wake-up call, particularly because most women with pre-eclampsia are young, healthy women.”

In fact, the 2011 American Heart Association guidelines for preventing heart disease in women identified pregnancy complications as a significant risk factor for the first time ever.

IMPORTANT:  If you’ve been diagnosed with preeclampsia, visit The Preeclampsia Foundation‘s excellent website, and participate in their Preeclampsia Registry, a research tool that will help investigators longitudinally track women like me who have ever been diagnosed with preeclampsia.

And in order to further study the future health risks of such pregnancy complications, the MotHERS program recently launched a Mother’s Health Clinic. Women in the Kingston area are invited to attend the clinic for a 6-month postpartum assessment if they have had one of the following pregnancy complications:

• pre-eclampsia, gestational hypertension, HELLP syndrome, eclampsia, high blood pressure
• gestational diabetes or gestational impaired glucose tolerance
• preterm birth for any reason
• small baby (<5th percentile for your gestational age or <2500g at term)
• placental abruption that leads to delivery

Women who are seen in the Mother’s Health Clinic will have their weight and height checked, their waist and BMI measured, blood tests taken, and any information related to risk for heart disease collected.  Dr. Smith and his Queen’s Perinatal Research Unit team were recently awarded a $1.2 million Canadian Institutes for Health Research grant to undertake this study called “Antenatal Identification and Postpartum Cardiovascular Risk Assessment”.

Because we know that complications of pregnancy are linked to future cardiovascular disease, Dr. Smith observes:

“Too much of health care is spent reacting to disease after it’s happened, and not enough is spent on prevention. This is a place to start!”

As a further service to pregnant women, if you sign up on the MotHERS website (it’s free) and input your due date, you’ll receive email reminders throughout your pregnancy, information on what kinds of things to expect, what topics your health care provider will discuss, what tests will be ordered based on your gestational age, and links to useful external resources. You can also follow them on Twitter.

There’s even a new app for mothers, designed in collaboration with Dr. Smith’s MotHERS program at Queen’s University. After childbirth, it’s only natural that the baby becomes the focus for both the new mother and her physician. But it’s crucial that Mom’s health be maintained too – for her sake, and for her baby’s sake.

“A new phone app called Maternelle lets new mothers and health care providers track important maternal health indicators such as blood pressure, weight gain or loss, and other medical data directly on their smartphones. At the same time, Maternelle tracks the immunization records of young family members, ensuring that your baby’s record is always up available. Maternelle puts both you and your baby on the right track to a healthy future.  Find out more about the Maternelle app at the iTunes store“

.

* NEWS UPDATE March 14, 2012:  Tiny Baby = Later Heart Trouble for Mom?

A new study published in the journal Public Library of Science One reveals that women who give birth to babies who are underweight at full term are twice as likely to develop ischemic heart disease as other women.

Giving birth to an underweight baby was found to be associated with about the same amount of risk for developing heart disease as having high blood pressure or diabetes, even when adjusting for all the other risk factors. Study author Dr. Radek Bukowski of the University of Texas explained:

“We were especially surprised that when we adjusted for family medical history and known risk factors, such as smoking – which significantly increases the risk of heart disease and low birth weight infants – small-for-gestational-age remained a powerful independent risk factor for heart disease in the mothers.”

* Bukowski R, Davis KE, Wilson PWF (2012) Delivery of a Small for Gestational Age Infant and Greater Maternal Risk of Ischemic Heart Disease. PLoS ONE 7(3): e33047. doi:10.1371/journal.pone.0033047

See also:

• What Women Need to Know about Pregnancy Complications and Heart Disease
• Pregnancy Complications Strongly Linked to Heart Disease
• Do You Know the 2011 Heart Health Guidelines for Women?
• Pre-eclampsia from the MotHERS program experts
• The Preeclampsia Foundation‘s excellent website

.