Pregnancy and cardiovascular disease
Your heart works even harder during pregnancy, so partnering with your doctor while planning your first or subsequent pregnancies to decrease your risk of heart disease, or to manage any existing conditions is important.

PREGNANCY can be a time of joy and excited anticipation in a person's life. It can also be a time of great physical and emotional stress. But in the midst of all the colour picking and nursery prepping, it's more important than ever to maintain all your medical appointments.

If you haven't already, be sure to add your cardiologist to that list. In addition to our distinguished cardiologists, Partners Interventional Centre of Jamaica (PICJ) has other specialists on staff such as general practitioners and nutritionists who are dedicated to ensuring the health of mom and her bundle of joy.

Your heart works even harder during this delicate time, so partner with your doctor while planning your first or subsequent pregnancies to decrease your risk of heart disease, or to manage any existing conditions.

While most pregnancies are normal, in this post, Dr Lisa Hurlock takes us through some of the risks and complications that may arise during pregnancy, especially relating to the heart.

By now, we should be familiar with the most common signs of heart distress: shortness of breath, extreme tiredness, palpitations, and dizziness. However, these well-known indicators are also expected during pregnancy. How do pregnant women tell if what they are experiencing are exaggerated symptoms of pregnancy or symptoms of cardiovascular disease?

In general, cardiovascular disease in pregnant women will usually present — especially in women who have been absolutely normal before — in the second or third trimester with high blood pressure — a condition called pre-eclampsia. This can affect the kidneys and the brain leading to seizures (eclampsia). The treatment is to deliver the baby. Women who develop pre-eclampsia in pregnancy are more likely to develop hypertension later on in life. Naturally, the way we mitigate the risk of pre-eclampsia is how we manage patients with high blood pressure or hypertension:

• Use little or no added salt in your meals

• Stay well hydrated!

• Avoid excessive fried foods and junk foods

• Get enough rest

• Exercise regularly

Pregnancy comes with a unique set of physiological changes. The heart actually becomes bigger to accommodate the increased blood volume which supplies the placenta. Because of this, women often present with anaemia. As Dr Hurlock puts it, "The blood count is low, but there is increased blood volume, which means the heart has to be pumping harder, leading to more stress on the heart." Monitoring anaemia is important as, again, the symptoms overlap with those of heart disease. Mild anaemia is anticipated during pregnancy, but severe cases can be avoided by supplementing your iron, folate, and vitamin B complex intake. These vitamins and minerals can be found in:

• Green, leafy vegetables

• Dairy

• Whole grains and legumes

• Animal proteins

You can also talk to your doctors about adding supplements such as folic acid and other multivitamins. All of these work together to ensure the health of your red blood cells.

Dr Hurlock also warns about the risk of rheumatic heart disease. "When we think of pregnancy and heart disease, we think of a few conditions such as rheumatic heart disease, which begins as rheumatic fever in childhood." It is caused by an immune response to a bacteria called strep. This condition leads to the development of abnormal heart valves, specifically the mitral and aortic valves. Abnormal valves lead to a host of issues that make it difficult for your heart to function normally. If rheumatic fever is caught and treated early, severe heart valve damage can be avoided. Rheumatic heart disease is known to present during pregnancy.

The average childbearing age has also shifted to later years. Naturally, as we age, we become more susceptible to major health issues. Pregnancies also have a higher probability of being difficult. Dr Hurlock points out that many pregnancies these days happen after women may have experienced chronic illness, which puts them at risk of stroke or of developing heart disease. If you are over the age 40 and considering conceiving, your first step should absolutely be full physicals by your family doctor, obstetrician, and cardiologist.

Dr Hurlock recommends that women who have underlying cardiovascular disease and are considering conceiving, seek gestational counselling with the other parent before they try getting pregnant. This includes consulting your cardiologist and obstetrician for evaluation, as some patients may be on medication for their heart condition, which could be harmful to the development of the baby.

There are some conditions where pregnancy may be discouraged by doctors, namely congenital heart disease and severe pulmonary hypertension. However, in other cases of cardiovascular disease, with close monitoring by doctors and support from the woman's family or peer groups, the majority of patients are considered good candidates for pregnancy.

All that said, this post is not to discourage those trying to become pregnant! Being informed about the risks of pregnancy will empower you while talking to your healthcare providers, as you are better equipped to notice and understand the changes in your body. For example, we know swelling of the legs is normal in pregnancy, but acute or prolonged swelling warrants a visit to your doctor.

This article was contributed by Partners Interventional Centre of Jamaica

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