Pregnancy trauma predictor of heart disease
NASHVILLE, Tenn. (WSMV) - Heart disease is the number one killer in the U.S., taking the lives of 1 in 5 American women. A common pregnancy trauma can be a predictor of which women may experience heart problems in the future.
“Pregnancy is a stress test,” says Dr. Cornelia Graves, a high risk OBGYN at Tennessee Maternal Fetal Medicine in Nashville. “There are a lot of complications that can be life-threatening.”
One of those complications is preeclampsia, a disease that is unique to human pregnancy and is connected to problems with the heart. Preeclampsia develops either during pregnancy or within a month after delivery and is diagnosed by several symptoms including: persistent high blood pressure, high levels of protein in the urine, decreased blood platelets, trouble with the kidneys or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances.
“One of the things I think people really need to know about preeclampsia is we classify it as a heart disease,” says Dr. Graves. “In 2012, the American Heart Association said preeclampsia should be considered a failed cardiac stress test. I.e. if I put you on the treadmill, then you failed.”
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Pregnancy mimics many of the symptoms of heart disease: shortness of breath, swelling in the legs and feet, and skipped heart beats. It foretells the difficulty in diagnosing preeclampsia as many of the signs of impending preeclampsia are brushed-off as ‘normal’ pregnancy symptoms.
Preeclampsia affects 1 in 8 pregnancies in the U.S., but in populations with higher instances of high blood pressure and diabetes, the rate can go as high as 1 in 5 pregnancies - which is the rate in Tennessee.
“We also know that 1 in 5 women die of heart disease in this state, so it comes full circle,” says Dr. Graves.
Individuals with preeclampsia have a 3-to-4 times increased risk of developing heart disease, compared to normal individuals the same age. It doesn’t mean everyone who has preeclampsia is going to develop heart disease, but it does mean anyone who’s had it should be screened.
Dr. Graves found the risk disturbing in her patient population and approached Dr. Stacy Davis, a Nashville cardiologist, with the idea of creating a clinic to screen pregnant and post-partum women for heart disease.
“We consider preeclampsia a marker of future [heart] risk and it should be looked at as a window on the future,” says Dr. Davis. “It’s a chance to pause and say ‘what do I need to do to make myself as healthy as possible so I don’t get in trouble when I’m 55 or 60.’”
Together, they started a Cardio OB Clinic that prioritizes follow-up with women who experience heart events related to pregnancy. The clinic provides a place to educate women and screen them for future disease.
“Our clinic tries to identify those women who are at risk again in pregnancy,” says Dr. Graves. “We also have this post-partum component to determine which women would benefit from escalated care earlier in life.”
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Developing a screener
Dr.’s Davis and Graves work is part of a nationwide project to develop a screener test for preeclampsia.
“Just like we check blood sugars on pregnant women and all sorts of markers for clotting disorders, we now have this tool that can help us screen women and identify who’s at higher risk,” says Dr. Davis.
Their screener evaluates selected bio-markers, particularly: lipid profile, glucose profile, kidney profile and Inflammatory function of the heart. The doctors compare the tests alongside risk profiles and EKG’s to pinpoint an individual’s risk even earlier.
“They’re simple tests,” says Dr. Graves who explains that - until now - the results of these tests weren’t evaluated together as a means to understand cardiovascular risk in pregnancy.
The doctors developed the screener in collaboration with the University of California and USC and is now being evaluated by Medicaid and Medicare as potential for ‘Standard of Care’ in treatment of pregnant and post-partum women.
PTSD after preeclampsia
Most women with preeclampsia will deliver healthy babies and fully recover. However, some women will experience devastating complications, several of which may be life-threatening to the mother and baby.
“We’re looking at the post-traumatic stress of these adverse pregnancy outcomes – especially preeclampsia,” says Dr. Graves who explains that some women lose their babies while fighting preeclampsia.
Infant death is one of the most devastating consequences of preeclampsia. In the U.S., approximately 10,500 babies die from preeclampsia each year. Preeclampsia accounts for nearly 8% of all maternal deaths annually in the U.S.
“So its important that we get the patient through not just the physical aspects of this but the mental health aspects of this disease as well.”
Understanding Preeclampsia, clinically
The Preeclampsia Foundation shares these important symptoms that may suggest a presence of preeclampsia: headaches, abdominal pain, shortness of breath or burning behind the sternum, nausea and vomiting, confusion, heightened state of anxiety, and/or visual disturbances such as oversensitivity to light, blurred vision, or seeing flashing spots or auras.
For women who had preeclampsia and delivered preterm, had low-birthweight babies, or suffered from severe preeclampsia more than once, the risk of heart disease can be even higher. These risks first emerge in the years following a complicated pregnancy.
Some studies suggest, babies born from preeclamptic pregnancies have a higher risk of developing hypertension, coronary artery disease, and other chronic illnesses in adult life. These risks are especially true among babies who were delivered at term.
“This is your opportunity to take charge of your health and to have prevention,” says Dr. Graves. “Because if you’ve had preeclampsia, you are at an increased risk to have heart disease, high blood pressure, stroke, heart failure or heart attack.”
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