How Pregnancy Influences Your Future Health
By: Tabassum Firoz MD
tabassum.firoz@bpthosp.org
Dr. Firoz leads the Bridgeport Hospital Postpartum Heart Care Program for patients who have experienced high blood pressure problems during or after pregnancy.
Sara’s story*
Sara was 30 years old when she was pregnant with her first child. Towards the end of her pregnancy, Sara was diagnosed with pre-eclampsia, a high blood pressure condition that can affect organs like the brain, heart, lungs, and kidneys. It typically develops in the second half of pregnancy or during the postpartum period.
After the birth, Sara’s blood pressure became severely high and she was started on blood pressure medicines. For the next six months, Sara was followed in the Bridgeport Postpartum Heart Care Program for blood pressure management and heart health screening. She continued to need blood pressure medicines at six months postpartum, and was diagnosed with chronic hypertension, or long-term high blood pressure. During the heart health screening, she was also diagnosed with pre-diabetes, a condition where blood sugar levels are higher than normal but not yet at the level of diabetes.
Sara is now pregnant with her second child. Her blood pressure remains controlled on blood pressure medicines. Because of her history of pre-diabetes, she had an early sugar test and passed it.
How pre-eclampsia affects health later in life
In the U.S. in recent years, one in seven deliveries have been affected by pre-eclampsia. Women with certain medical conditions like high blood pressure, diabetes, and kidney disease are at increased risk of pre-eclampsia. Black women are disproportionately affected by pre-eclampsia for reasons such as chronic stress from social, structural, and environmental stressors that are frequently rooted in historic and present-day racism. Black women are also less likely to have their pre-existing medical conditions, such as high blood pressure, adequately managed before pregnancy.
Pre-eclampsia increases the risk of cardiovascular problems like chronic high blood pressure, heart disease, heart attack, and stroke later in life. Women who have had pre-eclampsia have approximately double the risk for chronic high blood pressure, heart disease, and stroke. That risk increases if pre-eclampsia occurred early, occurred in more than one pregnancy, or if the baby was small.
Pregnancy is considered to be a “stress test” for the heart, and high blood pressure conditions like pre-eclampsia that develop during pregnancy and after birth can expose underlying health issues that are considered to be risk factors for heart disease. For example, Sara was diagnosed with chronic high blood pressure and pre-diabetes after experiencing pre-eclampsia. While pre-eclampsia shares many of the same risk factors and pathways as heart disease, it is still not fully known whether this increased risk of cardiovascular problems is caused by pre-eclampsia or whether the person was already predisposed to developing pre-eclampsia and heart disease later.
Pre-eclampsia also increases the risk of diabetes and kidney disease in the future. Recently, some studies have shown that pre-eclampsia may also increase the risk of dementia, but more research is needed in this area.
Taking care of yourself
Heart disease is the leading cause of death in women, and it is increasing in women aged 35 to 54 years. Chronic high blood pressure can first appear in the first few years following a pregnancy affected by pre-eclampsia, even as early as six months to a year postpartum. Heart disease can occur as early as ten years after a pregnancy with pre-eclampsia.
Pregnancy can be seen as a window into long-term health, and having pre-eclampsia is a “heads up” to make changes now for a healthier tomorrow. The key is to make small and sustainable changes so that it becomes a lifestyle.
In my clinic, I go over these strategies with my patients to lower their risk of heart disease:
- Heart healthy nutrition: Heart healthy nutrition can lower blood pressure, cholesterol, and reduce the risk of heart disease. Focusing on adding fruits, vegetables, beans, legumes, and nuts on a daily basis can make a big difference.
- Get moving: New moms are busy, and it can be very challenging to prioritize exercise. Going for walks with the baby or doing a YouTube workout video at home can be more manageable with a busy schedule.
- Healthy body weight: It is recommended to return to pre-pregnancy weight by one year after birth.
- Good sleep: It can be challenging to get sleep as a new mom, so it is important to make sure that there are no sleep problems like obstructive sleep apnea. Women with underlying sleep apnea are predisposed to pre-eclampsia. Getting screened for sleep apnea is an important first step.
- Address stress: Women can experience many stressors after birth, such as financial stress from job instability, food insecurity, housing instability, and social isolation. Health care providers and community organizations can often help address some of these stressors.
- Prioritize mental health: Many women who have experienced pre-eclampsia during pregnancy or after delivery describe a traumatic birth experience. The pregnancy journey and birth experience can be difficult to process because of medical interventions, fear, and more time in the hospital than expected. With pregnancy complications like pre-eclampsia, patients often feel that the time in the hospital was a blur and are often left feeling like they don’t know all the details of what happened or what to expect moving forward.
Although more research is needed, studies have shown that stress caused by a traumatic birth experience is associated with conditions like postpartum depression, anxiety, and post-traumatic stress disorder. Your doctor can evaluate you and make recommendations around support, therapy, and/or medications.
- Monitor heart disease risk factors: I recommend monitoring blood pressure closely, and if possible, getting a home blood pressure monitor so patients can take charge of their own health. Every year, I recommend having blood sugar, cholesterol, kidney function, and urine checked.
- Connect with a primary care provider: A critical part of post-pre-eclampsia care is regular visits with a primary care provider (PCP). A PCP can manage all aspects of healthcare, including monitoring and managing blood pressure, screening for heart disease risk factors like blood sugars and cholesterol, navigating social and structural stressors, and addressing mental health. A PCP provides the frequent care and consistent voice that is needed after pre-eclampsia.
Pre-eclampsia is a scary and unwanted pregnancy complication, but knowing how it impacts heart health means that patients can take charge of their heart health early. Living a heart-healthy lifestyle and monitoring heart disease risk factors through regular check-ups makes 90% of heart disease preventable. No matter when a woman had pre-eclampsia, it is never too late to start on a journey towards good health.
Resources
- Pre-eclampsia Foundation: https://www.preeclampsia.org/
- American Heart Association: https://www.goredforwomen.org/en/
- Postpartum Support International: https://www.postpartum.net/
