Heart disease is the top cause of pregnancy-related deaths in California and probably throughout the U.S., many of which could be prevented by addressing related ailments, a study found.
Those most at risk of dying from pregnancy-related heart disease were black, obese or had a substance abuse issue, according to research presented today at the American Heart Association meeting in Dallas. About one third of the heart disease deaths could be prevented by better diagnosis and treatment as well as patient awareness, the authors said.
The number of California women dying of pregnancy-related complications tripled from 1996 to 2006, according to the study. U.S. rates have risen as well, the researchers said. Doctors and women need to be aware that symptoms like shortness of breath and being extremely tired are not only signs of pregnancy or being a new mom but could be indicative of an underlying medical issue like heart disease, said lead study author Afshan Hameed.
“In pregnancy and after pregnancy if there are any cardiac symptoms, there should be a workup more aggressively,” said Hameed, an associate professor of maternal fetal medicine and cardiology at the University of California at Irvine, in a telephone interview. “We should pay attention to the symptoms, to the clinical clues.”
After heart disease, preeclampsia, or high blood pressure during pregnancy, hemorrhage and blood clots in the amniotic fluid and in a blood vessel were the next top reasons for pregnancy-related deaths, she said.
About one in eight babies in the U.S. are born in California, Hameed said.
Researchers in the study examined the medical records of 732 women who died while pregnant or within one year of their pregnancy and found that 209 of the deaths were pregnancy related. Of those, 51, or about one quarter, were from some form of heart disease. Only about 6 percent of those women had been diagnosed with heart disease before pregnancy, the study found.
About 25 percent of women who died of heart causes were diagnosed with high blood pressure during their pregnancies, the paper showed. One third of patients who died had failed to seek care or delayed care, 10 percent refused medical advice and 27 percent didn’t identify their symptoms as heart related, the study found. The research also showed that the majority of those who died received incorrect or delayed diagnoses or doctors had given them ineffective or inappropriate treatments.
The study was funded by the California Department of Public Health, Maternal Child and Adolescent Health Division. The California Pregnancy Associated Mortality Review, a project of the state’s public health department to determine causes of pregnancy-related deaths and make recommendations, was initiated to address the rise in maternal mortality seen in California.
In a separate study of pregnancy health, researchers from the University of Alberta in Canada found that congenital heart defects, when the heart or blood vessels don’t develop properly before birth, in children may be linked with their mothers’ exposure to certain environmental toxins while pregnant. The findings suggest that some chemical emissions, particularly industrial air emissions including benzene, chloroform, methanol, lead, mercury and sulfur dioxide, may be linked to the heart abnormalities.
Congenital heart defects have dropped slowly in Canada since 2006, around the time the government tightened rules to lower industrial air emissions, said lead study author Deliwe Ngwezi, a student and research fellow in pediatric cardiology at the University of Albert.
“For now, consumers and health care providers should be educated about the potential toll of pollutants on the developing heart,” she said in a statement. “As we have observed in the preliminary results, when the emissions decrease, the rates of congenital heart defects also decrease.”