Taking care of your heart is important for women at any age and stage in life, but perhaps more so for women who are pregnant or thinking of becoming pregnant. The earlier you begin to adopt healthy lifestyle behaviors, the better off you’ll be when sporting your baby bump (and often, the easier it will be to conceive). However, it’s never too late to start making healthy choices, so begin where you are now and keep at it. That way, you’ll be at your healthiest in the event of an unexpected pregnancy health issue.
That’s what happened to Krystle Evans. Thirty-two weeks into her otherwise healthy pregnancy and with no previous history of heart disease, she experienced a rare form of a heart attack. Symptoms that she thought were her twins pressing against her ribs — shortness of breath and chest pain — were the first signs that something was wrong. Even when her symptoms worsened and included nausea, arm numbness and intense pain, she was prepared to tough it out. The possibility that she might be having a heart attack never entered her mind.
Thankfully, her OB urged her to go immediately to the ER at Medical City McKinney, where physicians quickly diagnosed her heart attack. Because the hospital had all of the expert specialty care that Krystle needed, doctors say that being at Medical City McKinney might have saved three lives that day.
“One of the things that was just a tremendous relief to me was to be here,” says Krystle’s OB/Gyn, Jerry Luciani, MD. “Because every single thing that you needed was here. They had a cardiologist who saw her, they did an echocardiogram. They’ve got maternal fetal doctors who are wonderful. And a great NICU.”
Krystle wants other pregnant women to feel empowered to share any pregnancy symptoms with their doctors, and to resist the urge to shrug them off as “nothing” or “normal.”
“I just want to bring awareness to other moms who might be carrying twins,” Krystle says. “If you feel like your heart is rapidly beating, have those conversations with your doctor. Tell them, even if it sounds weird to you or you feel it’s nothing. Have those conversations and make sure.”
Krystle’s advice works just as well for moms-to-be whether they are carrying one or multiple babies. Read on for more tips from our expert to help you manage a heart condition that you may already have or perhaps help prevent one from occurring during your pregnancy.
Tips to help manage and prevent heart disease before, during and after pregnancy.
Rely on your medical team. Pregnant women with heart disease need specialized care from a multidisciplinary team of experts. This is known as integrative medicine. “Integrative medicine is a combination of cardiology, high-risk OB, OB, maternal fetal medicine (MFM), and if needed, a neonatologist and anesthesiologist,” says Kamala Tamirisa, MD, a clinical cardiac electrophysiologist at Medical City Dallas. “It also includes the nursing staff from each one and then a very seamless communication. With everyone working together, patients have a better chance at the best outcomes.”
Medical City maternal fetal medicine physicians offer specialized care to women whose pregnancies are considered high risk, whether from issues with the mother’s health, the baby’s health or both. Age can also put a mom-to-be in the high-risk category.
“Older women are trying to conceive, and with age, the risk goes up because their comorbidities also go up,” says Dr. Tamirisa. “Comorbidities are chronic conditions such as high blood pressure and diabetes, and they put a woman at a higher risk for heart disease.”
The Maternal Fetal Institute at Medical City Healthcare provides the only labor and delivery program in North Texas with both a full-service children's hospital and adult hospital — including a Level IV Neonatal Intensive Care Unit (NICU) — in the same location. Mothers can recover with peace of mind knowing that high-risk pregnancy specialists and the region's leading pediatric hospital, Medical City Children's Hospital, are located on the same campus.
Additionally, world-renowned specialists at the Heart Center at Medical City Children’s Hospital provide patients of all ages who have congenital heart defects with leading-edge treatment and compassionate, comprehensive care.
Eat healthy food and manage your weight. “Obesity is a pandemic,” Dr. Tamirisa says. “The BMI (body mass index) of Americans is increasing and the more obese we are, the higher the risk for chronic conditions such as heart disease. Making healthy dietary choices is a key in attacking the obesity problem. As individuals, we need to make an effort; once we realize we're a bit overweight, we need to be proactive.”
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Know where your heart health stands. Heart disease is the leading cause of death during pregnancy, according to the American Heart Association (AHA). It might also surprise you to learn that American women are more likely to die from childbirth or pregnancy-related causes than women in other parts of the developed world — with Black women having three to four times the risk of white women, according to the CDC.
Heart disease is not just the leading cause of death during pregnancy; it’s the No. 1 cause of death among women at all stages of life. In fact, heart attacks are becoming more common in younger people — especially women — cites research published by the AHA. Learning what your heart disease risks are so that you can manage them is a positive way to take charge of your health.
Exercise regularly. Dr. Tamirisa says it’s important to exercise and stay active, whether it's getting that target number of steps a day or going to a gym. Walking is the easiest way to begin exercising, but swimming and yoga are also gentle, low-impact activities. Talk to your doctor before starting any new diet or exercise program.
Say no to stress. Stress can impact multiple areas of our lives and become a vicious cycle, says Dr. Tamirisa. “Stress can cause a lack of sleep or insomnia because of the fast-paced life we live. So, we don't get enough sleep and insomnia can lead to poor dietary habits and a poor routine in life. Stress can also cause obesity because with stress, a lot of people overeat.”
Here’s a two-fer tip: You can lower your stress and have a healthier heart just by breathing.
Don’t neglect your fourth trimester.
While it’s common knowledge that preconception is an important time during pregnancy, not everyone has heard that the fourth trimester of pregnancy, or the time after delivery, may be just as crucial. In 2018, the American College of Obstetrics and Gynecology recommended that postpartum care should become an ongoing process, rather than a single doctor visit, with services and support tailored to each woman's individual needs. It can be a vitally important to mom’s health, especially for women with a heart condition.
“The fourth trimester is the time period from when a woman delivers her baby to up to three months postpartum,” Dr. Tamirisa says. “During that time, the hormonal fluctuations are still ongoing. During pregnancy, whatever changes in the cardiac overload, volume overload, heart rate, and the hormonal changes, does not necessarily stop and immediately go back to normal once she delivers. It's not as if a light switch turned on and off. Those changes do take time. It can take around three months. So, during those three months postpartum, high-risk women and women with underlying chronic conditions need very close attention.”
“That is where we start thinking of prevention rather than focusing on treatment. If the same complication should happen with the next pregnancy or, if for example, this particular patient had gestational hypertension, which is high blood pressure during pregnancy, and that was not managed effectively because she delivered the baby and everyone focused on gynecological care, her cardiac health can be put on the back burner. When she goes on to have her next child, the hypertension that was not controlled during her first pregnancy can become a big problem. She can present with heart failure and many more complications during the second pregnancy. So, the fourth trimester is the key in prevention.”