Cardiovascular disease is the leading cause of pregnancy-related death in the United States. This has been the case for many years, and unfortunately, the U.S. has the highest maternal mortality rates among developed nations. That’s why managing cardiovascular risk during pregnancy is important — it’s not just a medical concern, it’s a critical public health and social issue.
Essentially, pregnancy is like a nine-month stress test because of all the physiological changes the body undergoes. These changes can reveal underlying cardiovascular risks: hypertension, diabetes, obesity and dyslipidemia — meaning abnormal cholesterol or triglyceride levels. Early identification and management of these risks are important for the health of both mom and baby.
Key cardiovascular risks in pregnancy
Key cardiovascular risk factors during pregnancy include:
- Hypertensive disorders (chronic and gestational hypertension)
- Diabetes (pre-existing and gestational)
- Obesity and excessive gestational weight gain
- Dyslipidemia (high cholesterol or triglycerides)
- Smoking and a sedentary lifestyle
In addition, there are unique pregnancy-related risk factors:
- Hypertensive disorders of pregnancy — preeclampsia, eclampsia and gestational hypertension
- Gestational diabetes mellitus
- Preterm birth and small-for-gestational-age infants
These all increase lifetime cardiovascular risk in the mother, meaning that women who have had any of the cardiovascular complications of pregnancy have a higher risk of heart attack, stroke or hypertension, and an increased lifetime risk of cardiovascular disease.
The importance of preconception counseling and screening
Many women interact with the health care system for the first time during pregnancy. They may not have a primary care doctor or established medical care. This presents a valuable opportunity for cardiovascular screening and preventive care. All women of reproductive age should undergo a cardiovascular risk assessment before pregnancy. This includes basic screening for blood pressure, glucose levels, cholesterol and body mass index, as well as assessments of smoking, diet, physical inactivity and psychosocial stress. In addition, it’s important to review chronic conditions, adjust medications for safety and discuss folic acid and other supplements.
Documenting any history of adverse pregnancy outcomes and family history of cardiovascular disease is also important because having cardiovascular issues during a first pregnancy automatically increases the chance of cardiovascular complications during a second pregnancy.
The earlier we detect problems and risk factors, the more we can implement timely interventions to reduce the complications of pregnancy for both mom and baby.
The role of team-based care
For women with existing cardiovascular disease or high-risk conditions, consultation with a multidisciplinary cardio-obstetrics (cardio-OB) team — composed of OB-GYNs, cardiologists, maternal-fetal medicine specialists, midwives and nurses — is critical. These teams develop a comprehensive care plan to improve maternal and fetal outcomes, manage individual risks and provide specialized monitoring throughout the postpartum period.
Lifestyle modifications and monitoring
Lifestyle changes can make a real difference. A healthy diet focused on whole foods, regular physical activity (150 minutes of moderate-intensity exercise per week) and appropriate weight gain based on pre-pregnancy body mass index are all key.
Blood pressure should be monitored regularly at home and during OB visits. Every pregnant woman should have a home monitor and know the signs of preeclampsia — severe headache, swelling, vision changes, abdominal pain, shortness of breath, confusion and sudden weight gain.
The fourth trimester
Many women can develop postpartum preeclampsia. The first 12 weeks postpartum are critical for maternal health — we call it “the fourth trimester.” Addressing blood pressure, blood cholesterol, contraception, mental health and cardiovascular risk factors and monitoring for delayed complications such as hypertension or heart failure — these can all happen during the first few weeks after delivery. Very close monitoring of blood pressure symptoms and follow-up with your OB and other doctors is critical.
In conclusion, managing cardiovascular risk during pregnancy is essential to protect both maternal and fetal health and reduce the leading cause of pregnancy-related death in the U.S. Early screening, preconception counseling and team-based care — including cardio-obstetrics specialists — play a crucial role in identifying and addressing these risks. Lifestyle changes, home monitoring and careful follow-up during the postpartum “fourth trimester” are also vital. Proactive, multidisciplinary care throughout pregnancy and beyond can improve outcomes and lower a woman’s long-term risk of heart disease.
Learn more about cardio-obstetrics at Northside Hospital Heart Institute.
Additional resource: American College of Cardiology’s CardioSmart website
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