August 2018 Highlights Uncategorized

What to Expect After You Are Expecting

Expectant mothers have no shortage of information available and during frequent visits with their doctors. However, the difference in preventative medical care and information between pregnancy and post-partum is vastly different, and this difference is leading to some worrisome health concerns for new moms.

More than half of pregnancy-related deaths occur after birth, and the U.S. is the only country in the world where maternal mortality rates are going up. A CDC Foundation analysis of data from four states found that nearly 60 percent of those deaths were preventable.

These findings led The American College of Obstetricians and Gynecologists (ACOG) to issue a formal opinion in April on updated recommendations for postpartum care.

This critical post-partum time is often referred to as the Fourth Trimester. Thanks to the ACOG opinion, this important time is getting much more attention for the health and well-being of new moms.

Things like gestational diabetes, which are common and treatable pregnancy complications, can also present serious post-partum complications. It is rare for anyone – either patients and healthcare providers –  to worry or discuss it.  Since it usually disappears after delivery, women do not get information about the long-term risks, and the woman doesn’t know that because it occurred (and disappeared after the birth), it’s still putting them at risk. Similarly, gestational hypertension (any high blood pressure during pregnancy), preeclampsia, preterm birth (deliveries before 37 weeks of gestation) all increase the future risk of heart disease- and yet rarely are discussed after delivery because the issues have often resolved.

Gestational diabetes rates have doubled in recent years from approximately four percent of women to around eight percent. It is a pregnancy complication that behaves similar to other forms of diabetes by interfering with how the body processes glucose but most often disappear after delivery. Because the blood sugar levels often normalize after delivery, most patients believe their risk has also disappeared.

Research shows that having gestational diabetes raises a woman’s risk of developing Type 2 diabetes, and increases the risk of future heart disease and stroke.

Simply having gestational diabetes also raises the risk of an expectant mother of having preeclampsia, a dangerous complication to both mother and the baby. Similarly to gestational diabetes, preeclampsia goes away after the birth of the baby.

Gestational diabetes can, and does, happen to anyone, there some general factors that can increase someone’s risk: being over 25 years-old, being overweight with a BMI of 30 or more, any personal or family history with diabetes, and ethnicity.

The most important thing for expectant and new mothers to know is to discuss any new medical issues that arise during pregnancy with their doctors. After the birth of a child, the mother needs to also focus on her own health and understand the implications of these adverse pregnancy outcomes and her own health and come up with a plan with her health care team to reduce future risks to her heart. Also, maintaining a healthy pregnancy with safe exercise and a healthy diet may help prevent these complications in the first place.

It is important that women receive information about the implications of these issues that arise during pregnancy. The partnership of the new mother with her obstetrician and other specialists to improve heart health is the key to impacting a women’s health.

Written by: Dr. Martha Gulati, MD, MS, FACC, FAHA Division Chief of Cardiology for the University of Arizona College of Medicine, Phoenix Physician Executive Director for the Banner – University Medicine Heart Institute

Gretchen Pahia

Dr. Martha Gulati is a co-author on the ACOG opinion is chief of cardiology at the University of Arizona College of Medicine, and physician executive director of the Banner – University Medicine Heart Institute in Phoenix, is bringing the concerning health concerns linked to cardiovascular issues in post-partum women.

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