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But a growing body of research suggests there’s another organ to consider: the heart.
“Cardiovascular disease risk assessment is important at any age, but especially during the childbearing years,” said Dr. Afshan Hameed, a cardiologist and professor of maternal-fetal medicine at the University of California, Irvine, “but I don’t think the awareness is there to the extent that it needs to be. It needs to be communicated to every woman who goes to her obstetrician-gynecologist.”
Cardiovascular disease is the number one cause of death among women and the leading cause of pregnancy-related deaths, and many of these deaths could be prevented if women were to talk more routinely about their cardiovascular risk, especially before, during, and after pregnancy, says Mary Canobbio, clinical nurse specialist in the Adult Congenital Heart Disease Program at the University of California, Los Angeles School of Nursing.
“The average woman considering pregnancy doesn’t think it will cause problems for her heart,” she says.
Here are five questions women should ask their OB-GYN about their heart health.
Can birth control affect the heart?
There are many different types of birth control, but the most commonly prescribed method is the oral contraceptive pill. There are three types of pill, all of which contain hormones – either a combination of estrogen and progesterone or progesterone alone.
However, birth control pills that contain estrogen have been shown to increase the risk of blood clots, stroke, and heart attack.
Canobbio recommends that women with a history of high blood pressure or blood clots refrain from taking estrogen. “Their gynecologists should examine them to see what type of birth control would be best for them. There are alternatives to hormone-based birth control.”
How does pregnancy affect the heart, and how can you prevent complications?
Ideally, women should optimize their health before becoming pregnant to prevent complications for themselves and their fetus, Canobio and Hameed said. That means maintaining a healthy weight, being physically active, eating a healthy diet, controlling any high blood pressure, and making sure blood sugar levels are within normal range.
“Most women don’t think about their hearts as much as they think about pregnancy, but women with risk factors like obesity, high blood pressure and diabetes should be concerned and talk to their doctor before they become pregnant,” Canobbio said. “These women are at higher risk of developing problems during pregnancy.”
Obesity, for example, can lead to high blood pressure, which many women may not even know they have, she says.
“It depends on how frequently you saw your doctor or obstetrician-gynecologist before you got pregnant,” Canobbio says. “They may not go because they don’t think they’re sick. We need to work with these women before they get pregnant to help them lose weight and get their blood pressure under control. They may be pre-diabetic and not know it. These are all risk factors that women who get pregnant may not even know about.”
Being overweight or obese increases the risk of gestational diabetes and preeclampsia, a high blood pressure condition that can harm both mother and baby and can progress to eclampsia, which can cause seizures. Obesity also increases the risk of having a baby with heart defects.
Dr Hameed said he has seen women in his clinic who were born with heart defects but didn’t mention it because they hadn’t had any recent problems. Women born with heart defects are at higher risk of giving birth to babies with heart defects.
“Women may have had heart defects repaired as children and not had them recur, but as patients get older, this can become important, especially when they become pregnant,” Hameed said. “Cardiovascular risk assessment should be done during every pregnancy and the postpartum period.”
Canobio said that applies to all women, not just those with risk factors or underlying health conditions.
“Even if women feel healthy, they need to be aware that today there are more concerns about a woman’s heart before pregnancy,” she said.
Hameed says women with risk factors or underlying medical conditions should talk with their health care team about the possible effects on their pregnancy, including foods or activities to avoid, how medications may affect the fetus, tests to undergo, and any other questions they may have.
Hameed said mothers who are high-risk should also check whether the hospital where they plan to give birth is equipped to deal with any complications that may arise during childbirth.
What symptoms during and after pregnancy are related to the heart?
Hameed says some symptoms women experience during and after pregnancy can be indicators of cardiovascular disease. For example, shortness of breath and fatigue may be overlooked if women think they’re just tired from pregnancy, but they could be symptoms of peripartum cardiomyopathy, a rare type of heart failure that occurs in the later stages of pregnancy or in the months after.
Hameed said it can also occur in women who have never been diagnosed with heart disease, and because it resembles pregnancy symptoms, women may not recognise it as a heart-related condition.
If I have pregnancy complications, will they affect my long-term heart health?
Pregnancy complications, also known as adverse pregnancy outcomes, include pregnancy-induced hypertension, preeclampsia, gestational diabetes, preterm birth, and low birth weight. Research suggests that women who experience adverse pregnancy outcomes are at higher risk of cardiovascular disease than women who do not.
“Pregnancy is a stress test for the cardiovascular system,” Hameed says, and women who experience adverse pregnancy outcomes or blood pressure-related problems during pregnancy “are already carrying one more risk factor for future cardiovascular disease.”
A 2021 American Heart Association scientific statement summarized evidence linking pregnancy complications to future maternal cardiovascular disease risk, with up to 15% of pregnant women in the United States experiencing such complications.
“During pregnancy, the heart has to work harder than usual to support both the mother and the baby,” said Canobbio, co-author of the report. Doing so could reveal weaknesses in the mother’s cardiovascular system that require careful monitoring for several years to come.
How does menopause affect the heart?
Estrogen is a natural hormone that offers some protection against heart disease in women. When estrogen levels drop during menopause, it puts women at higher risk for cardiovascular disease. Canobio says this is a good time to talk to your doctor, who may order tests to identify any risk factors that need to be addressed. It’s also important to check your family history.
“Many women don’t realise that the cardiovascular disease that their parents or grandparents developed as they aged can become a problem for them,” she says. “If you have a history of heart disease, stroke or high blood pressure, you should speak to your gynaecologist or family doctor to have your condition evaluated.”
Menopause can also cause many symptoms that can be treated with hormone replacement therapy, including hot flashes, night sweats, and sleep problems. Some research suggests that taking these therapies during early menopause may have some cardiovascular benefits, prevent type 2 diabetes, and stave off osteoporosis, according to a 2020 AHA report summarizing research in this area.
But a 2023 study published in the journal Hypertension found that at least one type of hormone replacement therapy may increase blood pressure risk, and other studies have shown that some hormone replacement therapies may increase the risk of blood clots in some women.
Canobio said women should discuss their personal risks and potential benefits of hormone replacement therapy with their health care team, ideally early in the menopause.
Hameed says no matter what stage of life they are at, women should ask their obstetrician-gynecologist and other members of their health care team about their heart health and what they can do to lower their risk.
“When we think about prevention, there are a lot of steps we can take,” she said. “We need to look at all of the risk factors for cardiovascular disease in women and help them modify them to prevent future cardiovascular disease development.”
