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Expectant mothers, especially older ones, should watch for signs of heart trouble as their pregnancies progress and their babies arrive.
A woman’s risk of having a heart attack while pregnant, giving birth or during the two months after delivery rose 25 percent from 2002 to 2014, a study published Wednesday in Mayo Clinic Proceedings found. The rate of patients who died remained high but steady over that period at 4.5 percent.
“Being aware is the biggest take-home message for women,” Dr. Sripal Bangalore, study co-author, interventional cardiologist and an associate professor of medicine at NYU Langone Health, told TODAY.
“Even though you are of child-bearing age, that does not completely protect you from having a heart attack. … That being said, I don’t want to exaggerate the risk — the risk is small.”
Still, the authors called the rise in heart attacks complicating pregnancy “remarkable” given that it happened despite advances in preventing heart trouble over the past decade.
One explanation may be that many expectant mothers are now older than in the past, and “advanced maternal age” — defined as 35 or over — was strongly associated with heart attack during pregnancy, the researchers wrote. Pregnant women 35 to 39 years old were five times more likely to suffer a heart attack than women in their 20s; those in their early 40s were ten times more at risk than women in their 20s.
“Age itself was one of the strongest predictors,” Bangalore noted.
Another reason may be that heart attacks have become easier to detect, making women and their doctors more aware of cardiac events.
Symptoms may be 'clouded'
For the study, the researchers analyzed more than 55 million pregnancy-related hospitalizations from January 1, 2002, to December 31, 2014, in the National Inpatient Sample database and found 4,471 cases of heart attacks. About 20 percent occurred in the weeks and months before birth, almost 24 percent during labor and delivery, and more than 53 percent in the weeks after birth.
The overall number of women affected was still relatively low: about eight cases per 100,000 women hospitalized during pregnancy and the first weeks after childbirth. In general, hormonal and other changes during pregnancy increase a woman’s risk of having a heart attack.
The diagnosis can sometimes be a challenge, Bangalore said. For example, pregnant women can have acid reflux and it becomes difficult to distinguish whether it's heartburn due to pregnancy or chest discomfort that may be caused by a heart attack. Some symptoms may also be “clouded” at delivery, Bangalore added. If a woman has received some sedation as she’s giving birth, she may not feel the typical chest pains.
This study found heart attacks were associated with advanced maternal age, smoking, high blood pressure, high cholesterol levels, diabetes, heart failure, anemia and cancer. They were also more likely to occur in women who were diagnosed with preeclampsia and those who delivered via C-section.
How best to treat heart attacks during pregnancy remains “uncertain,” the study noted, but fewer women died with invasive management, such as bypass surgery and other procedures, than when doctors took a conservative approach.
If you are pregnant, doctors offered these tips:
Be aware of classic heart attack symptoms
They include chest pain, chest pressure and discomfort, lightheadedness, dizziness, shortness of breath and an overall feeling of being uncharacteristically unwell or fatigued. These classic symptoms apply to pregnant women, too, Bangalore said.
Know the risk factors
If you are pregnant and over 35, and/or have high blood pressure, diabetes and or high cholesterol, pay special attention to your body. If you experience any troubling symptoms, let your doctor know right away.
Stop smoking, manage your high blood pressure or diabetes, and carefully monitor your weight gain if you are obese. Losing weight before you become pregnant is the best way to decrease the risk of problems caused by obesity, the American College of Obstetricians and Gynecologists advised. Obesity during pregnancy puts women at risk for serious health problems, including preeclampsia, a blood pressure disorder.