Pregnancy and heart disease

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Improving heart health outcomes for women who experience vascular conditions during pregnancy was one of the five key actions identified and agreed by attendees at the 2017 Women and Heart Disease Forum.

Cardiovascular disease risk associated with pregnancy has until recent times been poorly acknowledged, researched and understood. However, we now know:

Women who have been diagnosed with either pre-eclampsia or gestational hypertension are at increased risk of subsequent hypertension and cardiovascular disease. The relative risk of chronic hypertension is four times and ischaemic heart disease twice that of women who did not experience these conditions in pregnancy [1].

Hypertensive disorders of pregnancy affect five to ten percent of pregnancies worldwide. In Australia, 30,000 women each year will develop high blood pressure in pregnancy and 10,000 of these will lead to preeclampsia [2], [3].

Between five and ten percent of pregnant women will develop gestational diabetes, also associated with increased risk of Type 2 Diabetes and cardiovascular disease later in life. AIHW data collected in 2015 suggests that as many as 10.5 percent of Australian women may experience gestational diabetes [4].

There is currently limited information available for women to understand these vascular conditions, their implications for long-term cardiovascular health and actions they can take to reduce their risk.

Clinical management advice 

Guidelines and recommendations have been developed for pregnancy care and long-term management of cardiovascular risk in the United States, Europe and Australia.

The following is based on current best practice:

  • Hypertension in pregnancy and preeclampsia

    Clinical follow-up:

    1. An annual blood pressure check
    2. Regular (five-yearly or more frequently if indicated) assessment of other CV risk factors including serum lipids and blood glucose [1]. 

    Advice for women who have experienced hypertensive disorders of pregnancy:

    • Maintain a healthy weight
    • Eat a healthy diet
    • Engage in regular physical activity
    • Don’t smoke
    • Plan subsequent pregnancies with your obstetrician

    [1] Lowe et al. Society of Obstetric Medicine of Australian and New Zealand 2014. Guideline for the Management of Hypertensive Disorders of Pregnancy 2014. Sydney: SOMANZ.

  • Gestational diabetes

    Clinical follow-up:

    Oral Glucose Tolerance Test six weeks after the birth, then every two to three years (annually if planning subsequent pregnancies) [1].

    Advice for women who have experienced gestational diabetes:

    • Maintain weight within a normal range by following a healthy diet.
    • Take regular exercise – aim for 30 minutes of brisk walking five times a week.

    [1] Australian Diabetes in Pregnancy Society Consensus Guidelines for the Testing and Diagnosis of Hyperglycaemia in Pregnancy in Australia and New Zealand (modified November 2014).

Guidelines and tools

Current Australian and international guidance related to hypertension in pregnancy and long-term and cardiovascular risk:

More Information

For more information on pregnancy and heart disease watch the recording of the 2017 Heart Foundation Women and Heart Disease Forum

The following presentations from the forum are related to pregnancy and heart disease: 

  • Prof Gemma Figtree: Pregnancy as the ultimate cardiac stress test
  • Prof Will Parsonage: The burden of cardiac disease in pregnancy
  • A/Prof Karin Lust: Cross-disciplinary management of cardiac disease in pregnancy
  • A/Prof Deb Bateson: Contraception: options for women with heart disease
  • Dr Jane Tooher: The impact of pregnancy on future health
  • Prof Jon Hyett: Pre-eclampsia and its relationship to cardiovascular disease
  • A/Prof Sanjay Patel & Dr Clare Arnott: Postpartum vascular assessment and cardiovascular outcomes
  • A/Prof Greg Davis: The Pre-eclampsia P4 Study

Information for patients

 

 

[1] Lowe et al. Society of Obstetric Medicine of Australian and New Zealand 2014. Guideline for the Management of Hypertensive Disorders of Pregnancy 2014. Sydney: SOMANZ.

[2] L. Duley, The global impact of pre-eclampsia and eclampsia, Semin. Perinatol. 33 (2009) 130–137. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO 2011.

[3] Davis G et al Postpartum physiology, psychology and paediatric follow up study (P4 Study) – Study protocol. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health. 6 (2016) 374–379.

[4] RACGP. General practice management of type 2 diabetes 2016–2018. 13.3 Gestational Diabetes.