February 27, 2019

Pregnancy Complications May Influence Women’s Future Heart Health

By Ansley Waters, SWHR Science Programs Intern

Heart disease is the No. 1 killer of both women and men in the United States, accounting for one in every four deaths, according to the Centers for Disease Control and Prevention (CDC). Yet many women may not understand their risk for heart disease, which is often thought of as a “man’s disease,” or that there are critical differences in heart disease between women and men.

For example, heart attack symptoms may be more subtle for women, who are also less likely to receive optimal treatment during an attack. While women tend to develop heart disease about a decade later than men do, a study published in Circulation showed the incidence of hospitalization due to heart attack increased in women ages 35-54 from 1995-2014 and decreased in men of the same age. While women and men share some common risk factors for heart disease — including diabetes, lack of physical exercise, smoking, high blood pressure, high cholesterol, and age — other risk factors are specific to women, such as pregnancy complications.

Cardiologist Dr. Nieca Goldberg, medical director at the NYU Langone Joan H. Tisch Center for Women’s Health and a Society for Women’s Health Research Board member, says that a growing body of evidence shows women may have an increased risk of heart disease in the decades following a pregnancy in which they suffered from complications such as gestational diabetes or preeclampsia.

Gestational diabetes, which develops during pregnancy and causes abnormally high blood sugar, can be managed through a healthy diet and medication. However, research shows it may increase risk for Type II diabetes after pregnancy and may also increase risk for heart disease later in life. One study found that women who had gestational diabetes were more likely to be hospitalized for cardiovascular disease 25 years after pregnancy compared to women who did not have gestational diabetes.

Preeclampsia is a potentially fatal pregnancy complication that causes high blood pressure and affects nearly 5% of all pregnancies. The most effective treatment for preeclampsia is delivery, but if it’s too early in pregnancy, medications may be used to lower blood pressure, prevent seizures, and improve liver function. “Preeclampsia and hypertension during pregnancy can increase risk for cardiovascular disease nearly twofold,” Goldberg said, even after studies adjust for other risk factors, including BMI, age, and diabetes status.

The underlying mechanism behind the increased risk of heart disease in women who had preeclampsia remains unclear. However, Goldberg said studies have shown women who had preeclampsia have less flexible blood vessels even seven weeks postpartum, and less flexible blood vessels are more susceptible to plaque buildup over time. More research is needed on this connection to determine whether preeclampsia is simply revealing an already existing blood vessel issue or whether it may be causing potentially harmful changes to blood vessels.

In the meantime, clinicians need to consider pregnancy history during cardiac assessment. “What’s most important is that women have access to the health care system so that they can be regularly followed,” Goldberg said. She recommends that women see a doctor of internal medicine (who specializes in the prevention and treatment of adult diseases) to monitor these issues, instead of relying solely on their obstetrician-gynecologist. Additionally, she said that women with a history of complicated pregnancy should “consider seeing a cardiologist earlier in life, especially if they have a family history of heart disease.”