Cardiovascular disease is the leading cause of maternal death in the U.S., or more simply put, heart disease is the No. 1 killer of new moms. It can pose a threat to women’s heart health during pregnancy and later in life, making it important that women understand how to care for themselves and their babies.

Black women face a greater risk of developing high blood pressure, having a stroke, and complications during or immediately after pregnancy. Pregnancy-related deaths in the U.S. are rising at an alarming rate — and cardiovascular disease is the leading cause. Between 1987 and 2015, pregnancy-related deaths rose from 7.2 per 100,000 live births to 17.2 per 100,000 live births.
 
There is no one easy answer to explain the disparities, even when data is adjusted for socio-economic factors. We know that many young women juggle obligations and family responsibilities, leaving them less time to prioritize their health. This is why the American Heart Association and other leading health organizations are partnering with women, their health care teams, and communities to address this urgent issue. 
 
RISK FACTORS

There are four key risk factors for cardiovascular disease-related maternal mortality: Race/ethnicity, age, hypertension, and obesity.
 
RACE – POPULATIONS AT GREATER RISK:

  • Black women are over three times more likely than white women to die of cardiovascular-related pregnancy complications.
  • Black and American Indian/Alaska Native women are two to three times as likely as white women to die from any pregnancy-related cause.
  • Hispanic and Black women are more likely than white women to have dangerous complications during delivery.

Experts think many factors help explain the higher risk for some populations. The disparities might be due in part to differences in insurance coverage and access to care. But structural racism and other broad social and economic factors — known as social determinants of health — may also be at work. k. 

AGE: PREGNANCY RISK RISES WITH A WOMAN’S AGE

In the U.S., risk of pregnancy-related death in women 40 and older is nearly eight times as high as the risk in women 25 and younger.

Women 35 and older are at higher risk of having or developing conditions that make pregnancy complications more likely. Such conditions include chronic high blood pressure, preeclampsia, and gestational diabetes.

Increasing age can also amplify racial inequities. For instance, risk of pregnancy-related death in Black women under age 20 is 1.5 times that of white women. But Black women age 30 to 34 face 4.3 times the risk of white women that age.

WEIGHT: OBESITY IS A MAJOR PREGNANCY CONCERN

Pregnancy-related deaths rose sharply in the U.S. from 1997 to 2012. Some research suggests rising obesity rates could account for nearly a third of the increase.

Obesity is defined as a body mass index of 30 or higher. For a woman 5 feet 4 inches tall, that’s a weight of 174 pounds or more.

The heavier you are before you get pregnant, the greater your risk may be of pregnancy complications. Possible complications include:

  • preeclampsia, a high blood pressure disorder
  • gestational diabetes, which is diabetes diagnosed during pregnancy
  • sleep apnea, which can increase risk for gestational diabetes, preeclampsia, and other problems
  • stillbirth and cesarean delivery

If your BMI falls in the “overweight” or “obese” range (25 or higher), talk to your health care team about losing weight before getting pregnant. Also, it’s important to keep your weight gain while pregnant within medical guidelines. Too many extra pounds during a first pregnancy can increase preeclampsia risk, research has found.

BLOOD PRESSURE: THE HAZARD OF BLOOD PRESSURE

Rates of high blood pressure (hypertension) both before and during pregnancy have increased in recent decades.

Hypertension during pregnancy greatly increases the risk of heart attack and heart failure. Women with high blood pressure who get pregnant are also more likely to have pregnancy complications.

If you have high blood pressure and plan to get pregnant, work with your health care team to lower your blood pressure first. Also, some blood pressure drugs are not advised during pregnancy. Ask your team. Be sure to discuss short-term health risks if you’ve had fertility treatment. And tell your team if you are taking any supplements, including high-dose folic acid supplements. Some evidence suggests that high doses of prenatal supplements might increase the risk during pregnancy of a dangerous form of high blood pressure.

WHAT ARE SOME WAYS TO PREVENT COMPLICATIONS?

A healthy pregnancy is best for both mom and baby in the short and long term. Many of the healthy habits recommended before you became pregnant remain the same – like eating healthy, getting exercise, managing stress, and controlling blood pressure – but be sure to talk to your health care provider about your specific needs, health history, and any concerns you may have.

Making your heart health and overall wellness a priority is essential during pregnancy. This includes:

  • Visiting a health care provider regularly. Monthly visits are typical until 28 weeks. Then the frequency will increase to every two weeks or weekly as you get closer to your due date. Follow your health care team’s recommendations.
  • Taking medication as prescribed. Talk to your doctor about what to do if you miss a dose. Never stop medications without approval.
  • Reducing stress and managing anxiety. Some ways to calm down include meditating, spending time in nature and enjoying other hobbies.
  • Monitoring weight gain. Doctors will advise you how much weight is safe to gain based on your body mass index before pregnancy. Normal weight women with BMI of 18.5 to 24.9 who are pregnant with one baby are typically expected to gain 25 to 35 pounds. (The range is higher in a multiple pregnancy, such as if you’re carrying twins.)
  • Avoiding unhealthy habits such as smoking, alcohol and illegal drugs. 
  • Following extra precautions, if you’re older than 35. These include being aware of the increased risks, staying active, and getting early and frequent medical care.

Learn more by visiting GoRedforWomen.org/Pregnancy.

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