Take Care of Your Heart for Your Baby

Death among pregnant women frequently tied to preventable cardiac problems

(RxWiki News) Modern medicine has come a long way in reducing the number of women who die while pregnant or because of pregnancy. But women need to do their part too.

A recent study found that a significant percentage of women who died for pregnancy-related reasons had cardiovascular disease.

Although dying for pregnancy-related reasons is very rare, about eight in every 10 women who died because of these heart problems did not take actions that might have saved them.

Some did not seek medical care, others refused medical advice, and others did not realize they had heart-related symptoms.

Healthcare providers also did not always diagnose women properly or on time, or they did not properly treat the women.

Greater conscientiousness on the part of women and their care providers may help decrease the risk of cardiac deaths related to pregnancy, the study found.

"Attend all prenatal appointments."

This study, led by Afshan B. Hameed, MD, an associate professor of clinical cardiology, obstetrics and gynecology at the University of California, Irvine, aimed to better understand causes of pregnant women's deaths.

The researchers analyzed data gathered in a program called the California Pregnancy-Associated Mortality Review.

Between 2002 and 2005, there were a little more than 2.1 million live births, but 732 women died either while pregnant or within a year of giving birth.

The researchers determined that 207 of these deaths — about 28 percent of them — were related to pregnancy.

Among those related to pregnancy, about a quarter of them (53 women) were due to cardiovascular disease, including 33 women who died from cardiomyopathy.

In cardiomyopathy, the heart becomes weakened, which can cause an irregular heartbeat, heart failure, problems with valves in the heart or death.

Just under a quarter of the women dying from cardiovascular disease (22 percent) had also been diagnosed with high blood pressure or pre-eclampsia.

Pre-eclampsia is a pregnancy complication in which a woman has high blood pressure and protein in her urine. The only treatment is to have the baby.

The researchers examined the cardiovascular deaths for similarities and found that the women dying from cardiovascular disease in this group were twice as likely to be obese or to be black compared to women who died from non-cardiovascular causes.

While 42 percent of those who died from cardiovascular disease were obese, only 26 percent of women dying from other causes were obese.

Likewise, 39 percent of the women who died from cardiovascular disease were black, compared to 17 percent of the women who died from other causes.

Pregnant or postpartum women dying from cardiovascular disease were also more than twice as likely to have had substance abuse problems.

Just over a quarter of those who died from heart problems (27 percent) had documented substance abuse, compared to just 10 percent of those who died from other causes.

In addition, 31 percent of those who died from heart problems died at least 42 days after giving birth, compared to only 6 percent who died from other causes.

A closer examination of the cardiomyopathy cases revealed that women dying from this condition were also much more likely to be black and/or obese than women who died from other causes.

Women who died from cardiomyopathy were also four times more likely to have substance abuse problems: 37 percent of them had abused substances, compared to 9 percent of women who died from other causes.

A slightly higher percentage (30 percent) of women dying from cardiomyopathy had been diagnosed with high blood pressure or pre-eclampsia.

The researchers also looked at the time that elapsed between when a woman was diagnosed with a heart condition and her death.

Only 29 of the women had been diagnosed with their cardiovascular condition before they died. The average time that passed between experiencing symptoms and being diagnosed was 26 days.

The average time between being diagnosed and dying was 79 days, or about two and a half months.

The researchers determined that almost a third of the cardiovascular deaths (30 percent) may have been preventable.

This finding was due to the fact that patient behaviors contributed to 86 percent of the deaths, and health care provider actions (or inaction) contributed to 71 percent of the deaths.

For example, health care providers either made the wrong diagnosis or waited too long to diagnose the women.

Or, the providers gave ineffective or inappropriate treatments to their patients, the researchers found.

Meanwhile, about a third of the women who died waited too long to see a doctor or never sought medical care.

Another 10 percent of women who died refused the medical advice given to them, and just over a quarter (27 percent) never recognized that their symptoms were related to heart problems.

"Earlier recognition and referral of a patient [with symptoms] by obstetric providers may help prevent serious morbidity [health problems] and mortality [death]," the researchers wrote.

Sarah Samaan, MD, a cardiologist with Legacy Heart Center in Dallas-Fort Worth who was not associated with this study, said that an important take-away message from this study is that heart-related complications of pregnancy are often preventable. They can be successfully treated when they do occur, she said.

"However, in both cases, it is critical that women do all they can to take care of their own health," Dr. Samaan said. "That means maintaining a healthy body weight, avoiding drugs of abuse and making physician checkups a priority."

She said that increased blood pressure during pregnancy requires treatment for both the mother's and the unborn child's health.

"Likewise, a medically supervised weight loss program may be helpful for obese women who are pregnant or who are considering pregnancy," Dr. Samaan said. She noted that obesity also increases the risk of birth defects and other pregnancy-related complications.

"This study will also help doctors identify women who might be at higher risk for heart complications," she said. "In these situations, close follow up and referral to a high risk OB or other specialist may be appropriate, even if the woman has no obvious signs of heart problems."

This study was presented November 17 at the American Heart Association's Scientific Sessions 2013.

Because the study was presented at a conference and has not yet been published in a peer-reviewed journal, its findings should be interpreted cautiously.

The research was funded by the California Department of Public Health. The authors reported no potential conflicts of interest.

Review Date: 
November 18, 2013