How Cardiovascular Disease Makes Maternal Mortality a Hundred Times Higher

The heart and arteries work hard during pregnancy and after delivery. It’s important to pay close attention to them and take care of them. First to avoid immediate risks: it is estimated that 150,000 women of childbearing age in France have a cardiovascular disease. They face the risk of significant complications for their health and that of their babies if they don’t receive the proper care. Cardiovascular complications during pregnancy also increase the risk of developing a cardiovascular disease later in life, especially after menopause, and require special attention during this period. For World Heart Day, Women’s Cardiovascular Healthcare Foundation has compiled responses to a list of frequently asked questions about this important time in a woman’s life: before conception, during pregnancy, and after delivery with a special focus on women who already have a cardiovascular disease before becoming pregnant. Pregnancy: a physiological test of cardiovascular stress
The body has an unexpected capacity for physiological adaptation that allows the placenta to develop properly. This new vascular organ will enable the baby to grow after it’s conceived. “It is believed that cardiovascular adaptation during pregnancy is similar to high level endurance athletes,” says Dr. Marjorie Richardson, cardiologist at University Hospital of Lille. “Very early in the pregnancy, the size of the heart cavities increases, the vessels dilate, and the heart beats faster to provide increased blood flow to the placenta and the baby. Delivery also requires the heart to work harder due to the contractions and expulsion, the pain, the bleeding and the anesthesia.” Pregnancy: may reveal heart or artery disease
Pregnancy isn’t a disease and will proceed normally in the vast majority of cases. However, the increased work load on your heart caused by pregnancy can aggravate a heart or artery disease that had been mitigated, or even reveal the disease, which occurs most often during the third trimester when the heart’s output becomes very high. The placenta is an organ that provides nourishment and, in some cases, it doesn’t develop correctly which prevents the baby from growing correctly and sometimes has serious consequences on the mother’s health. “Cardiovascular disease is the leading cause of maternal mortality in most Western countries. In France, results from studies on maternal mortality show that hemorrhage is the leading direct cause of death while cardiovascular disease is the number one indirect cause,” says Prof. Claire Mounier-Vehier, MD, cardiologist at University Hospital Lille and cofounder of Women’s Cardiovascular Healthcare Foundation. “It is estimated that 150,000 women of childbearing age in France have a cardiovascular disease. If these patients don’t receive appropriate care during pregnancy, the risk of complications for their babies is 15 times higher and their risk of death is 100 times higher.” (Roos-Hesselinck EHJ 2013 and 2019) Essential support “It’s crucial for a woman with a cardiovascular disease to receive guidance from her gynecologist, her primary doctor and her cardiologist so that her pregnancy can be as safe as possible,” says Prof. Geneviève Plu-Bureau, MD, head of the gynecology unit at Port-Royal hospital in Paris. It’s recommended that the patient use contraception until they receive the green light from the team of cardio-obstetrics experts in order to plan the pregnancy under optimal conditions for the mother and child. Source: Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). Roos-Hesselink J, Baris L, Johnson M, De Backer J, Otto C, Marelli A, Jondeau G, Budts W, Grewal J, Sliwa K, Parsonage W, Maggioni AP, van Hagen I, Vahanian A, Tavazzi L, Elkayam U, Boersma E, Hall R. Eur Heart J. 2019 Dec 14;40(47):3848-3855. doi: 10.1093/eurheartj/ehz136.