Obesity crisis is worsening heart disease risks during and after pregnancy: Experts
Growing rates of obesity are contributing to more heart disease risks during and after pregnancy, experts warn.
People with obesity are more at risk of potentially lethal pregnancy complications like diabetes, hypertension, and pre-eclampsia. Those conditions increase the risk of heart disease and stroke, according to a recent report from the American Heart Association — a major concern, because heart disease is already the leading cause of pregnancy-related deaths.
"When comparing heart disease and poor pregnancy outcomes in women, we notice that obesity is a link," Dr. Sadiya Khan, lead author of the paper and assistant professor of medicine at Northwestern University Feinberg School of Medicine, told ABC News.
Obesity is an inflammatory condition that can damage blood vessels and make cells resistant to insulin, experts say. This ultimately contributes to the development of diseases like high blood pressure, high cholesterol and diabetes.
Obesity mixed with the expected hormonal changes during pregnancy, creates a perfect storm that can be detrimental to the pregnant person and baby, Khan says. The combination of changes from obesity and changes from pregnancy can lead to gestational diabetes, for example, she says.
Obesity is also linked to abnormal development of the placenta, research shows. That can increase the risk of pre-eclampsia, a complication characterized by high blood pressure and organ damage.
Regardless of weight, high blood pressure or diabetes during pregnancy can go away after delivery. However, people who had those conditions during pregnancy still have a higher chance of getting heart disease in their lifetime, research shows.
One study, published earlier this month, found pregnant people who had high blood pressure, diabetes, pre-eclampsia, a premature birth, or delivered a small baby were at risk of developing heart disease up to 46 years after delivery.
"There are two potential reasons that these complications during pregnancy cause heart disease long term, " Khan said. "Either the complication itself directly induces heart disease, or the complication is a reflection of someone's underlying risk."
Not everyone is equally at risk. Black women have a disproportionate risk of complications during pregnancy, like preeclampsia. Black women also have significantly higher rates of pregnancy-related death than white women in the United States, according to data from the Centers for Disease Control and Prevention.
"There is a growing awareness of the black maternal mortality crisis," Dr. Natalie Bello, Director of Hypertension research at the Smidt Heart Institute at Cedars-Sinai Medical Center and Co-Chair of the American College of Cardiology Reproductive and Cardio-Obstetrics Section, told ABC News. "We need to address the issues surrounding social and systemic barriers these women are faced with."
Screening and treating people for cardiac complications during pregnancy — whether they have obesity or not — can help reduce long-term risks, Bello says. In addition, anyone who has a complication during pregnancy should be monitored for heart disease, she says.
"Pregnancy may be the only time someone gets medical care," Bello said. "At that point they may not realize they carry a large risk, like obesity, for heart disease and complications during their pregnancy, so it is best to be screened early on in life to protect them during pregnancy and across the lifespan for their and their family's heart health."
With heart disease being the leading cause of death in women year after year, experts agree that lifestyle intervention during their entire life course needs to be the main driver to help reduce these unfavorable statistics.
"Blood pressure screening, a healthy weight, good sleep hygiene, are some examples someone can take to assure they are at a good place in regards to their heart health," Bello said. "The next steps would be to check how to maintain these healthy parameters so they can go into their pregnancy heart healthy for themselves and their baby."
Lily Nedda Dastmalchi, D.O., M.A., is a cardiology fellow at Temple University Hospital and a contributor to the ABC News Medical Unit.
