Pregnancy is a uniquely female event, attended by special joys that only a mother can understand. But pregnancy also presents unique cardiac risks. Understanding and managing these risks are essential for the young mother to maintain her health and ensure that she can be around to enjoy her children and grandchildren.

High blood pressure:
High blood pressure is the most common unfavorable cardiovascular consequence of pregnancy. During pregnancy, 1 in 10 women develops hypertension (blood pressure greater than 140/90). A more serious condition, preeclampsia, is present when a woman develops the combination of hypertension and protein in the urine at 20 weeks of pregnancy or beyond. Preeclampsia affects 3 to 5 percent of pregnant women and can be fatal if untreated.

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The good news is that both hypertension and preeclampsia disappear after the child is born. The bad news is that they may leave lasting effects. Hypertension during pregnancy (termed “gestational hypertension”) is associated with a small increase in later cardiovascular disease.

If a woman develops hypertension during pregnancy, she should make sure to stay on top of her cardiovascular health. This means a full cardiovascular screening six months after the delivery to check blood pressure, cholesterol, body mass index (BMI) and blood glucose. There is no need to see a specialist for this simple screening; a general practitioner or OB/GYN doctor can provide the answers that you need. Optimizing these risk factors will reduce the risk of problems down the road.

How much weight should you gain while pregnant?:

Weight gain during pregnancy is normal and desirable. But too much weight puts both the mother and baby at risk. For the mother, excess weight increases the risks of developing hypertension, diabetes and heart disease, particularly if the weight “sticks” after the birth.

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The excess weight also creates problems for the baby. Children born to overweight and obese mothers have double the risk of developing obesity and diabetes in adulthood, and are more likely to have high blood pressure and unfavorable cholesterol values.Before becoming pregnant, a woman should optimize her weight. Once pregnant, it is critically important to avoid excessive weight gain. The Institute of Medicine has formulated recommendations for appropriate weight gain during pregnancy:

Mother’s starting weight    Recommended weight gain while pregnant
Normal 25-35 pounds
Overweight 15-25 pounds
Obese 11-20 pounds

Should you exercise during pregnancy?:
Yes! Exercise during pregnancy helps expectant mothers to avoid excessive weight gain, and is perfectly safe. Studies have shown that babies whose mothers exercised during pregnancy have healthier hearts and are more likely to be born at a healthy weight, than babies with sedentary moms. Don’t let being pregnant slow you down. Exercise for you and for your baby.

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Cardiac emergencies during pregnancy:

Peripartum cardiomyopathy-

We all know that swelling of the ankles, shortness of breath and fatigue are common during pregnancy. But if they arise or worsen suddenly in the last trimester or within a few months of delivery, they may be symptoms of peripartum cardiomyopathy, a life-threatening problem that causes a dramatic drop in heart function. Affecting one in 3,000 women who gives birth, peripartum cardiomyopathy is 16 times more common in African American women, particularly those with high blood pressure.The clue to diagnosis of peripartum cardiomyopathy is the sudden development of worsening symptoms—swelling of the ankles, shortness of breath, fatigue—in an otherwise normal pregnancy. The key to recovery is to recognize the symptoms and start treatment early. With appropriate treatment, 94 percent of women survive and more than half recover to full heart functioning. But the condition is prone to recur with subsequent pregnancies. Women whose heart function does not recover should not become pregnant again.

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Aortic dissection-

The most serious cardiovascular complication of pregnancy is aortic dissection, a tear in the aorta. Women with Marfan syndrome or a bicuspid aortic valve are at particular risk for this problem during pregnancy. If you have a heart murmur, Marfan syndrome or a known aortic valve abnormality, you must see a cardiologist for an echocardiogram (ultrasound of the heart) before becoming pregnant. If the test reveals a serious problem, fixing it before becoming pregnant is the safest course.When aortic dissection occurs, it causes sharp, tearing pain in the chest or back. If a pregnant woman develops sudden and severe chest pain or back pain, it must not be ignored. While this condition requires emergency open-heart surgery, we can usually save both the mother and the baby.

How many kids should you have?:

Recognizing that pregnancy can affect the heart, researchers recently tackled an interesting question: Is there a certain number of pregnancies that minimizes health risks? An observational study of 1.3 million Swedish women garnered media attention with its suggestion that the “magic” number is two. In that study, women who had two children tended to have the lowest risks of heart disease and stroke.While the relationship between number of kids and cardiovascular disease is interesting, this sort of study can’t prove causality—we don’t really know if having a certain number of kids is truly healthier for the mother. At this point, your discussion of family size includes you and your partner, not your cardiologist.No matter what you decide in terms of number of children, pay attention to your heart during (and after) pregnancy. See your doctor regularly during the pregnancy. Watch your weight.  If you develop high blood pressure, remember to have it checked again six months after delivery. Take these simple steps to ensure a long and healthy life with your family.

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