Experts warn that the incidence of this condition in Argentina is on the rise, and already reaches 16% of pregnancies. Is hypertension during pregnancy an indicator of later cardiovascular disease?
Pregnancy is a physiological situation in which the body puts certain mechanisms into operation. Every pregnant woman has cardiovascular changes regardless of their age and their underlying diseases. Thus, there is an increase in cardiac output, that is, the work performed by the heart to expel a volume of blood appropriate to the needs of the body by increasing the heart rate throughout the pregnancy and the volume of blood expelled in each beat. Another important change is that which occurs with blood pressure, which according to this cardiovascular adaptation to pregnancy, will fall in the first 20 weeks of gestation and then try to rise to values similar to those that had this mother before pregnancy.
The 20th week of gestation, then, is an important point for cardiologists since this is where the pressures begin to rise and problems may begin to manifest themselves. For this reason, specialists recommend carrying out a cardiological check-up from the beginning of pregnancy, not only to control the pressure but also to warn of the presence of any heart disease ignored until then. In turn, they emphasize the importance of cardiological monitoring throughout the life of those women who had hypertensive disorders.
The blood pressure drops during the first 20 weeks of gestation and then try to rise to values similar to those that had this mother before pregnancy
This is one of the topics addressed during the 44th edition of the Argentine Congress of Cardiology, organized by the Argentine Society of Cardiology (SAC), which took place in Buenos Aires from October 18 to 20 and which is considered the scientific meeting most important Spanish-speaking in the cardiovascular area and fourth in relevance internationally.
” As of week 20 the cardiac output doubles, the heart rate rises, and the pressure begins to rise, so this may be the moment where heart disease begins to become evident,” said the plant doctor at the Hospital de Clínicas José of San Martín Analía Aquieri.
As explained by the specialist of the Cardiology Division, on the one hand, there is the group of women who have heart disease prior to pregnancy; This is the case of those who were born with heart disease but who, thanks to scientific advances and surgical techniques, reach adulthood in good condition and can become pregnant. “On the other hand, more and more often chronic hypertensive patients who get pregnant, this happens because you can reach motherhood at older ages, between 40 and 45 years.”
As these women are larger, they have a higher risk of developing diabetes, obesity or having high cholesterol. In addition, usually do not do physical activity and do not follow a healthy diet or smoke more, all this makes them more likely to develop hypertension in pregnancy.
“Hypertensive disorders of pregnancy are the third cause of maternal death in the country, it is known that increases both mortality and morbidity both maternal and fetal. As of 2009 local data showed that the incidence of these disorders in pregnancies was 13% and in recent years they have exceeded approximately 16% The increase is due to the mother’s advanced age, which generally goes hand in hand with higher levels of obesity, diabetes, high cholesterol, lack of physical activity and healthy dietsAquieri said. Today at age 45 with a fertility treatment a woman can get pregnant, but the cardiovascular risk is much higher than at 23 years. There are more cardiovascular risk factors at that age and this makes it possible for the mother to have more complications during her pregnancy. ”
Official data until 2010 show that hypertensive disorders complicate around 10% of pregnancies
During pregnancy, a woman can trigger a disease called preeclampsia, which affects all maternal organs. It can manifest with high pressure, as well as seizures, edema, proteinuria (loss of protein in the urine), depending on its severity. This entity has in common with cardiovascular disease the presence of damage to the wall of blood vessels; This alteration is responsible for the increase in cardiovascular risk throughout his life.
Official data up to 2010 show that hypertensive disorders complicate around 10% of pregnancies. Its severe forms, preeclampsia, and eclampsia, account for about 4.4% of all births.
“Those women who suffer from hypertension, eclampsia or preeclampsia during pregnancy increase the risk of cardiovascular problems in older adults several times, which is why they should have a more careful follow-up from the cardiological point of view, in order to avoid that over the years appear events such as unstable angina, myocardial infarction or cerebrovascular accident. Something similar is observed with gestational diabetes (diabetes that appears during pregnancy) since they are also more likely to develop cardiovascular problems in the future, “said cardiologist Lucia Kazelian, member of the Heart and Women Group of the Argentine Society of Cardiology (SAC).
During the cardiological consultation, data should be collected about how it was during pregnancy because this data shows the possibility of developing cardiovascular risk factors. “You always have to ask if you had children and how were the pregnancies, because if you had any of the complications mentioned (hypertension, preeclampsia, diabetes) you have to follow more frequently in search of the emergence of risk factors for treatment, different of the woman who had normal pregnancies, “remarked Kazelian.
According to data from the National Health Secretariat, in 2016 diseases of the circulatory system were responsible for one in three deaths of women in the country. Within this group, the most frequent causes were heart failure (28.5%), stroke (21.2%) and ischemia (19%). Hypertensive diseases accounted for 9.9% of cases.