As cardiologists and other medical specialists grow increasingly aware of big differences in the heart and circulatory health of men and women, researchers also are prodding doctors who take medical histories of female patients to be sure to ask simple but important questions about their experiences with problem pregnancies.
That’s because vital preventive information can be surfaced, if clinicians learn, for example, that their patients had preeclampsia, “a complication that occurs in about 5% of pregnancies and in which dangerously high blood pressure can lead to seizures, organ failure, and death,” according to Stat, a science and medical news site. As Stat reported:
“Women who have preeclampsia have more than twice the chance of developing cardiovascular disease later in life compared to women who had pregnancies without it …Today, a growing subset of care providers is advocating for closer follow-up of the millions of people who have had preeclampsia and other complications during pregnancy that signal an increased risk for cardiovascular disease. Given that about one in three women in the U.S. have cardiovascular disease, better screening of people with pregnancy complications could help protect them before they develop the disease in the first place.
“‘If somebody said to you, “You know, there’s a way that we can identify which women are [likely] to develop heart disease down the road,” wouldn’t you want to screen for it?’ said Graeme Smith, head of obstetrics and gynecology at Queen’s University School of Medicine in Canada. ‘Well, we already have that tool, and it’s pregnancy complications.’”
Stat detailed why researchers have drilled down on problem pregnancies as a predictor of possible serious future problems for too many women:
“Cardiovascular disease is responsible for about one in five deaths in women in the U.S., more than any other cause — including all forms of cancer combined. Black women … are particularly vulnerable: In the U.S., Black adults are substantially more likely to die from heart disease than their white, Hispanic, or Asian or Pacific Islander counterparts.
Researchers, Stat reported, raised concerns about doctors’ screening women for potential cardiovascular issues, especially with standardized risk calculators, “which take about a dozen standard data points to predict a person’s likelihood of having a major event, such as a heart attack or stroke, in the next 10 years”:
“Regardless of their other risk factors, for the most part, patients who are young and female have a very low chance of having a cardiovascular event in the next 10 years, so they are unlikely to get recommendations for serious lifestyle interventions or medication. But they may still be heading down a path to a fatal event later in life. Some 10 to 15% of pregnancies have at least one complication that is linked to later heart disease. In addition to preeclampsia, these include other forms of gestational hypertension; gestational diabetes; preterm delivery; low birth weight; and placental abruption.
“People who experience miscarriages and stillbirths are also at greater risk of heart disease. Additional reproductive health conditions — including the early arrival of periods, polycystic ovary syndrome, infertility, and early menopause — have also been linked to increased risk.
The calculators too often fail to account for women-specific risks, which may not be included except in fuller, more intensive screening, Stat reported:
“[A] large national 2014 survey revealed that only 16% of primary care physicians and 22% of cardiologists were using these full guidelines. The failure of health-care providers to screen for these sorts of early warning signs is in keeping with the long-standing pattern in which women’s risk for heart disease is chronically underestimated by medical professionals — as well as by women themselves.”
Researchers, Stat reported, have much to learn about problem pregnancies and cardiovascular disease, including whether one triggers the other or amplifies a predisposition in some women. And what steps, natural and otherwise, including breast feeding, can reduce future heart and circulatory problems?
More concretely, the studies have focused on finding ways to get women to be more aware of not only the heightened risks they may confront with cardiovascular conditions and problem pregnancies, but also to get doctors to diagnose and to provide sustained attention and treatment. Women may be so focused on their newborns and families that they fail to heed their own significant health needs. As they take time to see doctors during the children’s early lives — for shots, exams, and other routine and urgent care — women too often neglect to see their own doctors and to keep up healthful, recommended care regimens, which might include taking medications that could reduce their risk of heart and circulatory disease.
Experts also have yet to determine how many lives could be saved by doctors paying more attention to women’s cardiovascular risks, especially as indicated by pregnancy problems. They lack, for now, the long-term dig into persuasive data about better, long-term cardiovascular care for women who had problem pregnancies.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on expectant women, babies, and children by abuse, neglect, and injury, especially by health workers and caregiving facilities. The record is clear that women suffer excessive mistreatment in the medical system and it has become shocking to see with pregnancies, especially with women of color.
The United States, as the wealthiest and purportedly most advanced nation in the world, racks up an unacceptably bad record on the health of its expectant moms and infants. As USA Today reported on a new study by the March of Dimes:
“Preterm births last year reached their highest peak since 2007 – with more than 383,000 born before 37 weeks of gestational age in the United States … In 2021, roughly 10.5% of U.S. babies were born premature, according to the annual March of Dimes “Report Card,” which rated the United States at D+. The score dropped from its C- rating in 2020, when the preterm birth rate saw its first decline in six years, a slight decrease to 10.1%. The report released this week found disparities widened between white mothers and Native and black mothers, who are already 62% more likely to have a preterm birth and nearly three times as likely as white moms to die of childbirth-related causes …
“Preterm births can be caused by various health conditions in the birthing parent, like high blood pressure and diabetes, as well as stress, problems with the uterus or placenta, infection, or inflammation. Being born premature can lead to significant developmental complications in babies, including undeveloped respiratory systems causing breathing problems, and hearing, vision, and behavioral issues.”
Even before the pandemic, patient advocates had spoken out, rightly, about the terrible inequity of maternal care received by women of color, black women especially. It has imperiled even prominent patients like Beyonce and tennis legend Serena Williams. It is unacceptable — and its harms, including deaths, are preventable. As health critics have pointed out, repeatedly, we know how to deal with the problem, why aren’t we?
We have much work to do to safeguard pregnant patients, especially black women, and to ensure that they and their newborns have a great shot at long, healthy, and joyous lives.
