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At age 34, Leah Bahrencu was the picture of heart health. “I’m a group fitness instructor and nutrition coach,” says Bahrencu, who lives in Austin. But after she got pregnant with twins, her OB/GYN flagged her blood pressure at a 30-week checkup. “I normally have low blood pressure, so it was high for me,” she says.

But another doctor told her not to worry; her reading still fell in a normal range.

Over the next few weeks, Bahrencu developed indigestion, swelling and shortness of breath. “I felt awful, but I assumed that was normal for a twin pregnancy,” she says. At her 34-week appointment, something was wrong. Her blood pressure was sky-high, and her liver was failing. “I had to go in for an emergency C-section and was hospitalized for months afterwards,” she says.

Bahrencu had a severe form of <a href="https://www.consumerreports.org/high-blood-pressure/high-blood-pressure-during-pregnancy-is-on-rise-a3417684861/" target="_blank">preeclampsia, or high blood pressure during pregnancy</a>. Fortunately, she recovered, but she still needs checkups for her heart. Because of her history of preeclampsia, she’s at least twice as likely to develop heart disease over her lifetime, according to a <a href="https://www.ahajournals.org/doi/10.1161/circoutcomes.116.003497" target="_blank">2017 study in the journal Circulation</a>.

Bahrencu’s experience highlights the importance of <a href="https://www.ahajournals.org/doi/10.1161/circoutcomes.116.003497" target=_blank>cardiovascular health in pregnancy</a> for even the healthiest people. Another alarming reminder came with the news that champion U.S. sprinter <a href="https://www.washingtonpost.com/health/2023/06/19/tori-bowie-pregnancy-black-women/" target=_blank>Tori Bowie</a>, 32, died last month as a result of “complications of childbirth,” according to a medical examiner’s report. The Washington Post reported that “the medical examiner in Florida’s Orange County identified two potential contributing factors to her death: <a href="https://www.washingtonpost.com/wellness/2023/06/14/what-to-know-eclampsia-preeclampsia/?itid=lk_inline_manual_9" target=_blank>eclampsia</a> … and respiratory distress, which can happen when blood pressure gets too high.”

For your heart, pregnancy is “similar to running on a treadmill for nine months,” says Afshan Hameed, a specialist in maternal-fetal medicine and a clinical professor of cardiology at the University of California at Irvine. “It’s like a cardiac stress test.”

Throughout your pregnancy, your body increases blood volume by 30 to 50 percent. Your heart beats faster to move more blood throughout the body. “These changes support a growing fetus, but it puts an extra workload on the mom’s heart,” says Kathleen Young, a cardiologist and co-director of the Mayo Clinic Cardiovascular Obstetrics Clinic in Rochester, Minn.

And if pregnancy is a marathon, labor and delivery is the final sprint. Blood pressure and heart rate can increase further during labor and delivery. And the effects of pregnancy on heart health don’t disappear right after the baby’s born. “The heart is still under extra stress as hormones fluctuate and the extra blood from your uterus returns to circulation,” Young says.

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With all the pressure on the heart, pregnancy may reveal undiagnosed cardiovascular issues, such as problems with blood vessel function or congenital heart defects (structural issues of the heart present at birth), says Gina Wei, the National Heart, Lung and Blood Institute’s senior scientific adviser on women’s health. In people who already have <a href="https://www.consumerreports.org/high-blood-pressure/healthy-blood-pressure-levels-what-to-know-a1188192017/" target=_blank>high blood pressure</a> or <a href="https://www.consumerreports.org/nutrition-healthy-eating/how-to-lower-blood-sugar-with-food-a1186209685/" target=_blank>diabetes</a>, it may also worsen those conditions and increase their likelihood of having a cardiac event.

Even if you don’t have a heart problem, nearly 20 percent of pregnant people develop complications that can damage the heart or blood vessels, such as preeclampsia, gestational diabetes and premature birth.

These conditions may resolve after pregnancy, but they may also cause blood vessel changes that nearly double the risk of developing heart disease later in life, Wei says. But only 1 in 5 women are aware that pregnancy can threaten heart health, according to a <a href="https://www.jacc.org/doi/10.1016/j.jacc.2017.05.024" target=_blank>survey in the Journal of the American College of Cardiology</a>.

And the risk isn’t only in the future. Up to 4 percent of all pregnant people have or develop heart disease during pregnancy — and research shows that number is on the rise. Cardiovascular diseases — diseases that affect the heart or blood vessels — is the leading cause of death during pregnancy and in the year after giving birth, accounting for 27 percent of pregnancy-related deaths, <a href="https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/05/pregnancy-and-heart-disease" target=_blank>according to the American College of Obstetricians and Gynecologists</a>.

Risk factors for developing heart problems during pregnancy include high blood pressure, obesity and age. One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843194/" target=_blank>research review published in 2019 in the journal Medicina</a> shows that women who are 35 or older are more likely to have heart-related issues during pregnancy compared with their younger counterparts. More women are delaying childbirth until their 30s and 40s, which, in part, explains the rising prevalence of pregnancy-related heart disease, says Elizabeth Langen, a clinical associate professor of obstetrics and gynecology and co-director of the cardio-obstetrics program at the University of Michigan.

Racial inequities play a role, as well. For example, <a href="https://pubmed.ncbi.nlm.nih.gov/28697109/" target=_blank>non-Latina Black women</a> have three to four times the odds of dying of heart disease during pregnancy compared with White women.

But most of these deaths are avoidable with the right preventive measures, early detection and the right treatment. The problem is that heart issues are easily overlooked, misdiagnosed or mistreated, Langen says. Fatigue, swelling and chest pain can be normal pregnancy symptoms, but they may also signal a heart problem.

One of the first steps to take — as soon as you’re thinking about getting pregnant — is creating a plan with your doctor to reduce heart disease risk factors, such as quitting smoking and reaching a <a href="https://www.consumerreports.org/health/dieting-weight-loss/whats-a-healthy-weight-for-you-a1049560797/" target="_blank">healthy weight</a>, Wei says.

This move can protect your heart during pregnancy — and for years down the road. One <a href="https://www.ahajournals.org/doi/10.1161/JAHA.120.017216" target=_blank>study in 2021 in the Journal of the American Heart Association</a> found that first-time moms with heart disease risk factors before pregnancy or during their first trimester had greater odds of having a complication, such as preeclampsia or gestational diabetes. They were 7 to 15 percent more likely to develop high blood pressure two to seven years after giving birth.

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Addressing heart health before pregnancy is best, but you can do a lot to reduce your risk even if you are already pregnant.

Get screened early. One <a href="https://stacks.cdc.gov/view/cdc/51660" target=_blank>analysis from the CDC Foundation</a>, an independent nonprofit group that supports the Centers for Disease Control and Prevention, revealed that 68 percent of pregnancy-related deaths caused by heart issues are preventable. Some of the main causes of these deaths included delayed diagnoses and missed screenings. If your OB/GYN doesn’t bring it up, ask them to do a heart health screening.

If you have an existing heart issue, talk to your doctor. People who already have heart problems may need to work with a cardiologist throughout their pregnancy. You may need a change in your current treatment, such as switching to a medication that’s safer during pregnancy, or taking baby aspirin to reduce your odds of preeclampsia.

Keep moving. Staying active helps to keep your weight, blood sugar and blood pressure in check, Young says. <a href="https://pubmed.ncbi.nlm.nih.gov/28401531/" target=_blank>One review published in 2017</a> by Italian scientists showed that doing about 30 to 60 minutes of aerobic exercise two to seven days a week reduced the risk of high blood pressure during pregnancy by 46 percent.

Speak up about your symptoms. Signs of heart trouble include shortness of breath, chest pain, racing heart, and swelling of the feet, ankles and lower legs. “Many of these symptoms overlap with typical pregnancy symptoms,” Young says. “But if anything feels new, unusual, or out of proportion, don’t brush them off. Talk to your doctor.”

Scale back on highly processed foods. Fast foods, sodas, chips and other <a href="https://www.consumerreports.org/nutrition-healthy-eating/what-is-a-processed-food/" target=_blank>ultra-processed foods</a> are often high in calories and sodium, which contribute to high blood pressure. <a href="https://pubmed.ncbi.nlm.nih.gov/35956418/#:~:text=Meta%2Danalysis%20of%20cohort%20studies,Neonatal%20outcomes%20showed%20no%20association." target=_blank>Brazilian scientists showed</a> that women who ate a diet high in these foods during pregnancy were 48 percent more likely to develop gestational diabetes and had 28 percent higher odds of having preeclampsia.

Focus on fruits, vegetables and whole grains. These foods serve up fiber, which can help keep your blood sugar and hunger in check. They’re also sources of vitamins and minerals that support heart health, such as potassium. Research shows that getting a potassium-rich diet may help lower blood pressure, especially in women who get too much sodium.

Prioritize your postpartum appointments. When you’re busy caring for a newborn, your own doctor’s appointments may get pushed to the wayside. As many as 40 percent of women skip their postpartum checkups, according to the American College of Obstetrics and Gynecology. But two-thirds of heart-related deaths due to pregnancy occur during the year after a baby’s birth. Make sure that you follow through on your follow-up appointments.

Share your pregnancy history. At future appointments, tell your doctor about any complications you had during pregnancy. Many health-care providers overlook this important topic. According to a <a href="https://www.jacc.org/doi/10.1016/j.jacc.2017.05.024" target=_blank>survey of primary care physicians published in the Journal of the American College of Cardiology</a>, only 16 percent ticked all the recommended boxes, such as asking about pregnancy complications, when assessing heart disease risk in women.

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Read more at <a href="http://www.consumerreports.org/">ConsumerReports.org</a>.

Sharon Liao

Preeclampsia, other heart risks of pregnancy to watch for 

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