Mommy Matters: The Long-Term Health Implications of Pregnancy and Childbirth

If you have a new baby, you’re probably juggling more things than you can count right now. But, as hard as it might seem, it’s important to put caring for yourself on your to-do list, especially now. And it’s a priority you should maintain as your child grows.

During Women’s Health Month in May — but really all year round — preventive cardiologist Heather Johnson, M.D., wants to remind new moms that the self-care steps they take now can impact their health well into the future.

“We know you're focused on the baby, on recovering after delivery, focusing on sleep, work-life balance — just life's craziness in general,” says Dr. Johnson, with the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital, part of Baptist Health. “What we've realized is that this particular segment of time is really important for your long-term health moving forward.”

Is There Really A ‘Fourth Trimester’?

Most expectant parents break pregnancy down into three trimesters, anticipating the baby’s birth. Over the past 20 years, the term “fourth trimester” has been added to the popular consciousness, referring to a newborn’s first three months outside the womb.

Heather Johnson, M.D., a preventive cardiologist with the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital.

During those early days, babies are adapting to feeding, sleeping, external stimulation and interacting with the world.

At the same time, moms are adjusting, too — learning to read their baby’s cues, trying to establish a feeding routine, redefining their identity and getting whatever sleep they can, when they can. They are also experiencing many physical changes — including healing from the birth, hormonal swings and other physical stresses.

Before delivery, the mother’s health is monitored quite closely. After birth, the focus often shifts to the health of the baby. But it’s still important for new mothers be proactive about getting the care they need — and deserve — after delivering. Across the United States, statistics indicate an average of 40 percent of women do not seek postpartum care, according to the National Institutes of Health.

The American College of Obstetricians and Gynecologists (ACOG) recommends that mothers have initial contact with their OB-GYN within three weeks after delivery and a comprehensive postpartum visit no later than 12 weeks after delivery.

“The fourth trimester, those three months after pregnancy, are absolutely important. Postpartum care is a crucial time to make sure Mom is safe and healthy,” Dr. Johnson says. “Just as babies need care and attention during the fourth trimester, so do mothers.”

This is also a key window for women to take stock of their cardiac risks, both now and in the future, Dr. Johnson says. “Every woman should have an evaluation, particularly higher-risk women,” she says.

Focusing on Blood Pressure and Long-Term Cardiac Health

There are many metrics to consider for maternal health: blood sugar, weight loss, physical activity, avoiding nicotine, managing cholesterol and supporting mental health. A significant concern should also be monitoring and achieving a healthy blood pressure, Dr. Johnson says.

Uncontrolled high blood pressure can lead to immediate health complications such as seizures, stroke and heart attack. And it can have long-term implications by damaging the heart and arteries, as well.

“In the days and weeks after the baby is born, we want to see the mother’s blood pressure drop back down to more normal levels – below 140/90,” Dr. Johnson explains. “For some patients, that doesn’t happen and for others, their blood pressure may increase dramatically after delivery.”

Postpartum hypertension is one of the primary causes of hospital readmission for new mothers. According to the Centers for Disease Control and Prevention, hypertensive disorders of pregnancy account for nearly 10 percent of maternal deaths within 42 days after having a baby.

“Sometimes  it can develop right after pregnancy,” Dr. Johnson explains, adding that even when postpartum hypertension resolves, “It can be a contributor to a woman’s future risk of heart disease down the road. Not to be alarming, but it means that we, as women, need to have our heart checkup.”

After the baby’s delivery, new mothers should continue taking blood pressure readings once or twice a day, Dr. Johnson says.

Postpartum hypertensive disorders are more likely to affect women who have experienced high blood pressure or related problems, like preeclampsia, during pregnancy. But they can happen to any woman, underscoring the importance of regular blood pressure readings.

Blood pressure can be affected by delivery pain, medications and fluids, but it normally peaks three to six days postpartum. Pregnancy-induced hypertension, however, can last up to six months or more after delivery, which is why early diagnosis and treatment offer the best possible outcomes.

There are also other pregnancy-related heart issues, such as cardiomyopathy, a condition affecting the heart muscle that can occur before, during, or after pregnancy. "This process is reversible if the diagnosis and treatment is done on time," she says, "but it’s crucial to follow up with a healthcare provider during and after pregnancy."

Taking the Long View

 

Andrea Vitello, M.D., cardiologist at Baptist Health Miami Cardiac & Vascular Institute.

Heart disease is the No. 1 cause of death among women, surpassing cancer. Even women who do recognize the seriousness of heart disease sometimes think they personally are not at risk or too young for heart disease. Nothing is further from the truth, says cardiologist Andrea Vitello, M.D.

“By identifying risk factors, the idea is to be proactive in our approach to preventing cardiovascular illness and be aggressive at implementing lifestyle changes and medical treatments, if necessary, to prevent heart disease,” says Dr. Vitello, who leads the Women’s Heart Program at Baptist Health Miami Cardiac & Vascular Institute.

There’s a growing recognition that pregnancy history is connected to heart health, even years later. In particular, six pregnancy-related complications — high blood pressure, gestational diabetes, preterm delivery, small-for-gestational-age delivery, pregnancy loss or placental abruption — significantly increase a woman’s risk for developing cardiovascular disease later in life, according to the American Heart Association.

For example, high blood pressure in pregnancy, called gestational hypertension, increases a woman’s risk of cardiovascular disease later in life by 67 percent, and increases the odds of a stroke by 83 percent. Gestational diabetes is associated with a 68 percent higher risk of heart disease even if the diabetes resolves after delivery. Preterm delivery before 37 weeks has been found to double the risk of developing cardiovascular disease and is strongly associated with stroke.

The impact on a woman’s health may not be seen for 10 years, or even longer, after her pregnancy, current research shows.

Dr. Johnson says the goal is to care for all women across the entire age spectrum. “We recognize women are often busy caring for others and not focusing on themselves,” she says. But there’s a lot at stake.

“Throughout the country there has been an increase in heart attacks and strokes in women younger than 55 years old, which highlights the importance of addressing heart risk factors,” Dr. Johnson says. “We want to make sure that women receive a timely diagnosis and timely treatment of heart disease, but we also want to do all we can to encourage prevention.”